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| Plan Name | CHAMPION DISCS, INC MEDICAL & DENTAL BENEFIT |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CHAMPION DISCS, INC. |
| Employer identification number (EIN): | 953894688 |
| NAIC Classification: | 326100 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2023-01-01 | GAVIN MUIR | 2024-07-11 | DAVID DUNIPACE | 2024-07-11 |
| 502 | 2022-01-01 | GAVIN MUIR | 2023-11-21 |
| 2023: CHAMPION DISCS, INC MEDICAL & DENTAL BENEFIT 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: CHAMPION DISCS, INC MEDICAL & DENTAL BENEFIT 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | First time form 5500 has been submitted | Yes |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |||||||||||||||||||||||
| Policy contract number | L03254 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |||||||||||||||||||||||
| Policy contract number | L03254 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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