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KELCOURT PLASTICS, INC. PREMIUM ONLY PLAN 401k Plan overview

Plan NameKELCOURT PLASTICS, INC. PREMIUM ONLY PLAN
Plan identification number 501

KELCOURT PLASTICS, INC. PREMIUM ONLY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

KELCOURT PLASTICS, INC. has sponsored the creation of one or more 401k plans.

Company Name:KELCOURT PLASTICS, INC.
Employer identification number (EIN):953726892
NAIC Classification:326100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KELCOURT PLASTICS, INC. PREMIUM ONLY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-01-01DANIEL PERUSHEK
5012014-01-01DANIEL PERUSHEK
5012013-01-01DANIEL PERUSHEK
5012012-01-01PATRICK MICKLE
5012011-01-01PATRICK MICKLE
5012010-01-01PATRICK MICKLE
5012009-01-01PATRICK MICKLE

Form 5500 Responses for KELCOURT PLASTICS, INC. PREMIUM ONLY PLAN

2015: KELCOURT PLASTICS, INC. PREMIUM ONLY PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: KELCOURT PLASTICS, INC. PREMIUM ONLY PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: KELCOURT PLASTICS, INC. PREMIUM ONLY PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: KELCOURT PLASTICS, INC. PREMIUM ONLY PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: KELCOURT PLASTICS, INC. PREMIUM ONLY PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: KELCOURT PLASTICS, INC. PREMIUM ONLY PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: KELCOURT PLASTICS, INC. PREMIUM ONLY PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC20379
Policy instance 1
HEALTH SMART (National Association of Insurance Commissioners NAIC id number: )
Policy contract number0206941
Policy instance 5
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 62149 )
Policy contract number3099
Policy instance 4
WESTERN DENTAL SERVICES INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number002956
Policy instance 3
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number20501
Policy instance 2
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC20379
Policy instance 1
WESTERN DENTAL SERVICES INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number002956
Policy instance 3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 62149 )
Policy contract number3099
Policy instance 4
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1989-0030-41
Policy instance 5
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number20501
Policy instance 2
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC20379
Policy instance 1
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 62149 )
Policy contract number3099
Policy instance 4
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number20501
Policy instance 2
WESTERN DENTAL SERVICES INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number002956
Policy instance 3
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1989-0030-41
Policy instance 5
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1989-0030-41
Policy instance 5
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC20379
Policy instance 1
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number20501
Policy instance 2
WESTERN DENTAL SERVICES INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number002254
Policy instance 3
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 62149 )
Policy contract number3099
Policy instance 4
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 62149 )
Policy contract number3099
Policy instance 4
WESTERN DENTAL SERVICES INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number002254
Policy instance 3
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number20501
Policy instance 2
ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )
Policy contract numberC20379
Policy instance 1
DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number1989-0030-41
Policy instance 5
SIMNSA HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 62149 )
Policy contract number3099
Policy instance 4
WESTERN DENTAL SERVICES INC (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number2254
Policy instance 3
BLUE CROSS BLUE SHIELD OF ARIZONA (National Association of Insurance Commissioners NAIC id number: 53589 )
Policy contract number20501
Policy instance 2
BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC20379
Policy instance 1

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