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| Plan Name | R & S HEALTH AND WELFARE PLAN |
| Plan identification number | 515 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | DIXON-SHANE, LLC |
| Employer identification number (EIN): | 331004627 |
| NAIC Classification: | 325410 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 515 | 2018-05-01 | MELISSA GARNER | 2019-11-25 | ||
| 515 | 2017-05-01 |
| 2018: R & S HEALTH AND WELFARE PLAN 2018 form 5500 responses | ||
|---|---|---|
| 2018-05-01 | Type of plan entity | Single employer plan |
| 2018-05-01 | Plan funding arrangement – Insurance | Yes |
| 2018-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: R & S HEALTH AND WELFARE PLAN 2017 form 5500 responses | ||
| 2017-05-01 | Type of plan entity | Single employer plan |
| 2017-05-01 | First time form 5500 has been submitted | Yes |
| 2017-05-01 | Plan funding arrangement – Insurance | Yes |
| 2017-05-01 | Plan benefit arrangement – Insurance | Yes |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | SGD609562 |
| Policy instance | 7 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | VDT602248 |
| Policy instance | 6 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | SOK606619 |
| Policy instance | 5 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) | |
| Policy contract number | SGM608952 |
| Policy instance | 4 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 27465 |
| Policy instance | 3 |
| DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) | |
| Policy contract number | 0698640 |
| Policy instance | 2 |
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) | |
| Policy contract number | 00248862 |
| Policy instance | 1 |
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) | |
| Policy contract number | 27465 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 572172 |
| Policy instance | 3 |
| DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 ) | |
| Policy contract number | 0698640 |
| Policy instance | 2 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 908225 |
| Policy instance | 1 |
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