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| Plan Name | GEMINI MOUNTAIN MEDICAL DENTAL PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | GEMINI MOUNTAIN MEDICAL, LLC |
| Employer identification number (EIN): | 810875076 |
| NAIC Classification: | 423400 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2023-01-01 | MICHAEL F. LYONS | 2024-07-22 |
| 2023: GEMINI MOUNTAIN MEDICAL DENTAL PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | First time form 5500 has been submitted | Yes |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 ) | |||||||||||||||||||
| Policy contract number | DD000000665 | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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