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| Plan Name | FORMEL D USA DENTAL / VISION PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | FORMEL D USA, INC |
| Employer identification number (EIN): | 980425677 |
| NAIC Classification: | 441300 |
| NAIC Description: | Automotive Parts, Accessories, and Tire Stores |
Additional information about FORMEL D USA, INC
| Jurisdiction of Incorporation: | Georgia Department of States Corporations Division |
| Incorporation Date: | |
| Company Identification Number: | 1326951 |
More information about FORMEL D USA, INC
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2020-12-01 | ||||
| 502 | 2018-12-01 | ||||
| 502 | 2017-12-01 | ||||
| 502 | 2017-10-01 |
| Measure | Date | Value |
|---|---|---|
| 2020: FORMEL D USA DENTAL / VISION PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-12-01 | 619 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 310 |
| Number of retired or separated participants receiving benefits | 2020-12-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2020-12-01 | 11 |
| Total of all active and inactive participants | 2020-12-01 | 322 |
| 2018: FORMEL D USA DENTAL / VISION PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-12-01 | 464 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 550 |
| Number of retired or separated participants receiving benefits | 2018-12-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2018-12-01 | 36 |
| Total of all active and inactive participants | 2018-12-01 | 587 |
| 2017: FORMEL D USA DENTAL / VISION PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-12-01 | 318 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 458 |
| Number of retired or separated participants receiving benefits | 2017-12-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2017-12-01 | 16 |
| Total of all active and inactive participants | 2017-12-01 | 475 |
| Total participants, beginning-of-year | 2017-10-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 309 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 24 |
| Total of all active and inactive participants | 2017-10-01 | 333 |
| 2020: FORMEL D USA DENTAL / VISION PLAN 2020 form 5500 responses | ||
|---|---|---|
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Submission has been amended | No |
| 2020-12-01 | This submission is the final filing | No |
| 2020-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-12-01 | Plan is a collectively bargained plan | No |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: FORMEL D USA DENTAL / VISION PLAN 2018 form 5500 responses | ||
| 2018-12-01 | Type of plan entity | Single employer plan |
| 2018-12-01 | Submission has been amended | No |
| 2018-12-01 | This submission is the final filing | No |
| 2018-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-12-01 | Plan is a collectively bargained plan | No |
| 2018-12-01 | Plan funding arrangement – Insurance | Yes |
| 2018-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: FORMEL D USA DENTAL / VISION PLAN 2017 form 5500 responses | ||
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | Submission has been amended | No |
| 2017-12-01 | This submission is the final filing | No |
| 2017-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-12-01 | Plan is a collectively bargained plan | No |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | First time form 5500 has been submitted | Yes |
| 2017-10-01 | Submission has been amended | No |
| 2017-10-01 | This submission is the final filing | No |
| 2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2017-10-01 | Plan is a collectively bargained plan | No |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 637216 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 5945720 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 5945720 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 5945720 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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