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| Plan Name | CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN |
| Plan identification number | 504 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CHAMPION EMS |
| Employer identification number (EIN): | 752747708 |
| NAIC Classification: | 621900 |
Additional information about CHAMPION EMS
| Jurisdiction of Incorporation: | Michigan Secretary of State |
| Incorporation Date: | 0000-00-00 |
| Company Identification Number: | 702479 |
| Legal Registered Office Address: |
U.S. 41 P.O. BOX 266CHAMPION United States of America (USA) 49814 |
More information about CHAMPION EMS
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 504 | 2017-01-01 | JACOB WAMBOLDT |
| Measure | Date | Value |
|---|---|---|
| 2017: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 195 |
| Total of all active and inactive participants | 2017-01-01 | 0 |
| Total participants | 2017-01-01 | 0 |
| Measure | Date | Value |
|---|---|---|
| 2017 : CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2017 401k financial data | ||
| Total plan assets at end of year | 2017-12-31 | $0 |
| 2017: CHAMPION EMS HEALTH & DENTAL BENEFIT PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | This submission is the final filing | Yes |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||
| Policy contract number | 910769 | ||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||
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| IMA OF LOUISIANA (National Association of Insurance Commissioners NAIC id number: 68039 ) | |||||||||||||||||||||||||||
| Policy contract number | |||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||
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