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EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 401k Plan overview

Plan NameEMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC
Plan identification number 501

EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

DSG KANKAKEE LLC has sponsored the creation of one or more 401k plans.

Company Name:DSG KANKAKEE LLC
Employer identification number (EIN):461428147
NAIC Classification:713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-05-01
5012021-05-01
5012020-05-01
5012019-05-01
5012019-01-01

Plan Statistics for EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC

401k plan membership statisitcs for EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC

Measure Date Value
2022: EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2022 401k membership
Total participants, beginning-of-year2022-05-015
Total number of active participants reported on line 7a of the Form 55002022-05-014
Number of retired or separated participants receiving benefits2022-05-010
Number of other retired or separated participants entitled to future benefits2022-05-010
Total of all active and inactive participants2022-05-014
2021: EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2021 401k membership
Total participants, beginning-of-year2021-05-019
Total number of active participants reported on line 7a of the Form 55002021-05-019
Number of retired or separated participants receiving benefits2021-05-010
Number of other retired or separated participants entitled to future benefits2021-05-010
Total of all active and inactive participants2021-05-019
2020: EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2020 401k membership
Total participants, beginning-of-year2020-05-017
Total number of active participants reported on line 7a of the Form 55002020-05-015
Number of retired or separated participants receiving benefits2020-05-010
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-015
2019: EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2019 401k membership
Total participants, beginning-of-year2019-05-017
Total number of active participants reported on line 7a of the Form 55002019-05-017
Number of retired or separated participants receiving benefits2019-05-010
Number of other retired or separated participants entitled to future benefits2019-05-010
Total of all active and inactive participants2019-05-017
Total participants, beginning-of-year2019-01-015
Total number of active participants reported on line 7a of the Form 55002019-01-015
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-015

Financial Data on EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC

Measure Date Value
2023 : EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2023 401k financial data
Total income from all sources2023-04-30$26,025
Expenses. Total of all expenses incurred2023-04-30$20,156
Benefits paid (including direct rollovers)2023-04-30$6,679
Total plan assets at end of year2023-04-30$5,869
Value of fidelity bond covering the plan2023-04-30$8,000
Expenses. Other expenses not covered elsewhere2023-04-30$13,477
Net income (gross income less expenses)2023-04-30$5,869
Net plan assets at end of year (total assets less liabilities)2023-04-30$5,869
Net plan assets at beginning of year (total assets less liabilities)2023-04-30$0
Total contributions received or receivable from employer(s)2023-04-30$26,025
2022 : EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2022 401k financial data
Total income from all sources2022-04-30$24,426
Expenses. Total of all expenses incurred2022-04-30$24,426
Benefits paid (including direct rollovers)2022-04-30$11,754
Total plan assets at beginning of year2022-04-30$0
Value of fidelity bond covering the plan2022-04-30$1,000
Expenses. Other expenses not covered elsewhere2022-04-30$12,672
Net income (gross income less expenses)2022-04-30$0
Net plan assets at end of year (total assets less liabilities)2022-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2022-04-30$0
Total contributions received or receivable from employer(s)2022-04-30$24,426
2021 : EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2021 401k financial data
Total plan liabilities at beginning of year2021-04-30$0
Total income from all sources2021-04-30$20,113
Expenses. Total of all expenses incurred2021-04-30$20,113
Benefits paid (including direct rollovers)2021-04-30$9,755
Total plan assets at end of year2021-04-30$0
Total plan assets at beginning of year2021-04-30$0
Value of fidelity bond covering the plan2021-04-30$5,000
Expenses. Other expenses not covered elsewhere2021-04-30$10,358
Net income (gross income less expenses)2021-04-30$0
Net plan assets at end of year (total assets less liabilities)2021-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2021-04-30$0
Total contributions received or receivable from employer(s)2021-04-30$20,113
2020 : EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2020 401k financial data
Total plan liabilities at end of year2020-04-30$0
Total plan liabilities at beginning of year2020-04-30$0
Total income from all sources2020-04-30$16,988
Expenses. Total of all expenses incurred2020-04-30$18,468
Benefits paid (including direct rollovers)2020-04-30$9,022
Total plan assets at end of year2020-04-30$0
Total plan assets at beginning of year2020-04-30$1,480
Value of fidelity bond covering the plan2020-04-30$5,000
Expenses. Other expenses not covered elsewhere2020-04-30$9,446
Net income (gross income less expenses)2020-04-30$-1,480
Net plan assets at end of year (total assets less liabilities)2020-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2020-04-30$1,480
Total contributions received or receivable from employer(s)2020-04-30$16,988
2019 : EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2019 401k financial data
Total plan liabilities at end of year2019-04-30$0
Total plan liabilities at beginning of year2019-04-30$0
Total income from all sources2019-04-30$4,647
Expenses. Total of all expenses incurred2019-04-30$3,167
Benefits paid (including direct rollovers)2019-04-30$540
Total plan assets at end of year2019-04-30$1,480
Total plan assets at beginning of year2019-04-30$0
Value of fidelity bond covering the plan2019-04-30$5,000
Expenses. Other expenses not covered elsewhere2019-04-30$2,627
Net income (gross income less expenses)2019-04-30$1,480
Net plan assets at end of year (total assets less liabilities)2019-04-30$1,480
Net plan assets at beginning of year (total assets less liabilities)2019-04-30$0
Total contributions received or receivable from employer(s)2019-04-30$4,647

Form 5500 Responses for EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC

2022: EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Submission has been amendedNo
2022-05-01This submission is the final filingNo
2022-05-01This return/report is a short plan year return/report (less than 12 months)No
2022-05-01Plan is a collectively bargained planNo
2022-05-01Plan funding arrangement – InsuranceYes
2022-05-01Plan funding arrangement – TrustYes
2022-05-01Plan benefit arrangement – InsuranceYes
2022-05-01Plan benefit arrangement - TrustYes
2021: EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Submission has been amendedNo
2021-05-01This submission is the final filingNo
2021-05-01This return/report is a short plan year return/report (less than 12 months)No
2021-05-01Plan is a collectively bargained planNo
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan funding arrangement – TrustYes
2021-05-01Plan benefit arrangement – InsuranceYes
2021-05-01Plan benefit arrangement - TrustYes
2020: EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Submission has been amendedNo
2020-05-01This submission is the final filingNo
2020-05-01This return/report is a short plan year return/report (less than 12 months)No
2020-05-01Plan is a collectively bargained planNo
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan funding arrangement – TrustYes
2020-05-01Plan benefit arrangement – InsuranceYes
2020-05-01Plan benefit arrangement - TrustYes
2019: EMPLOYEE HEALTH PLAN OF DSG KANKAKEE LLC 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Submission has been amendedNo
2019-05-01This submission is the final filingNo
2019-05-01This return/report is a short plan year return/report (less than 12 months)No
2019-05-01Plan is a collectively bargained planNo
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan funding arrangement – TrustYes
2019-05-01Plan benefit arrangement – InsuranceYes
2019-05-01Plan benefit arrangement - TrustYes
2019-01-01Type of plan entitySingle employer plan
2019-01-01First time form 5500 has been submittedYes
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number60017NFA0719
Policy instance 1
Insurance contract or identification number60017NFA0719
Number of Individuals Covered6
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number60017NFA0738
Policy instance 1
Insurance contract or identification number60017NFA0738
Number of Individuals Covered11
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number60017NFA0738
Policy instance 1
Insurance contract or identification number60017NFA0738
Number of Individuals Covered7
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $8,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number60017NFA0738
Policy instance 1
Insurance contract or identification number60017NFA0738
Number of Individuals Covered9
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number60017 NFA 0738
Policy instance 1
Insurance contract or identification number60017 NFA 0738
Number of Individuals Covered6
Insurance policy start date2019-01-01
Insurance policy end date2019-04-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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