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| Plan Name | GROUP LIFE, DEPENDENT LIFE, AND ACCIDENTAL DEATH AND DISEMEMBERMENT INSURANCE FOR EMPLOYEES OF DALSIN INDUSTRIES |
| Plan identification number | 505 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | DALSIN INDUSTRIES, INC. |
| Employer identification number (EIN): | 411227778 |
| NAIC Classification: | 332900 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 505 | 2013-01-01 | BYRAN WIG | |||
| 505 | 2012-01-01 | BYRAN WIG |
| Measure | Date | Value |
|---|---|---|
| 2013: GROUP LIFE, DEPENDENT LIFE, AND ACCIDENTAL DEATH AND DISEMEMBERMENT INSURANCE FOR EMPLOYEES OF DALSIN INDUSTRIES 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-01-01 | 111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 0 |
| 2012: GROUP LIFE, DEPENDENT LIFE, AND ACCIDENTAL DEATH AND DISEMEMBERMENT INSURANCE FOR EMPLOYEES OF DALSIN INDUSTRIES 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-01-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 107 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 3 |
| Total of all active and inactive participants | 2012-01-01 | 111 |
| 2013: GROUP LIFE, DEPENDENT LIFE, AND ACCIDENTAL DEATH AND DISEMEMBERMENT INSURANCE FOR EMPLOYEES OF DALSIN INDUSTRIES 2013 form 5500 responses | ||
|---|---|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | Yes |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: GROUP LIFE, DEPENDENT LIFE, AND ACCIDENTAL DEATH AND DISEMEMBERMENT INSURANCE FOR EMPLOYEES OF DALSIN INDUSTRIES 2012 form 5500 responses | ||
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | First time form 5500 has been submitted | Yes |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | 000010168013 |
| Policy instance | 1 |
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) | |
| Policy contract number | 100-2089-00 |
| Policy instance | 1 |
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