401k Plan data: CROSSETT, INC. DENTAL PLAN plan

CROSSETT, INC. DENTAL PLAN 401k Plan overview

Plan Name	CROSSETT, INC. DENTAL PLAN
Plan identification number	503

CROSSETT, INC. DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

CROSSETT, INC. has sponsored the creation of one or more 401k plans.

Company Name: CROSSETT, INC.

Employer identification number (EIN): 250426840

NAIC Classification: 488510
NAIC Description: Freight Transportation Arrangement

Additional information about CROSSETT, INC.

Jurisdiction of Incorporation: Virginia Secretary of State

Incorporation Date: 2018-01-11

Company Identification Number: F208045

Legal Registered Office Address: 4701 Cox Rd Ste 285

Glen Allen
United States of America (USA)
23060-6808

More information about CROSSETT, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CROSSETT, INC. DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2015-01-01 JACK MARTIN JACK MARTIN 2016-07-28
503 2014-01-01 JACK MARTIN JACK MARTIN 2016-07-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2015-01-01	JACK MARTIN		JACK MARTIN	2016-07-28
503	2014-01-01	JACK MARTIN		JACK MARTIN	2016-07-28

Plan Statistics for CROSSETT, INC. DENTAL PLAN

401k plan membership statisitcs for CROSSETT, INC. DENTAL PLAN

Measure Date Value
2015: CROSSETT, INC. DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
2014: CROSSETT, INC. DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 406
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 106
Total of all active and inactive participants 2014-01-01 106

Measure	Date	Value
2015: CROSSETT, INC. DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
2014: CROSSETT, INC. DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	406
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	106
Total of all active and inactive participants	2014-01-01	106

Form 5500 Responses for CROSSETT, INC. DENTAL PLAN

2015: CROSSETT, INC. DENTAL PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	Yes
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: CROSSETT, INC. DENTAL PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )

Policy contract number

896791-099/000

Policy instance

Insurance contract or identification number	896791-099/000
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $105,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )

Policy contract number

896791-099, -00

Policy instance

Insurance contract or identification number	896791-099, -00
Number of Individuals Covered	106
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,059
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $89,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $7,469
Insurance broker organization code?	3
Insurance broker name	THE HDH GROUP, INC.

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Company Name:	CROSSETT, INC.
Employer identification number (EIN):	250426840
NAIC Classification:	488510
NAIC Description:	Freight Transportation Arrangement

Jurisdiction of Incorporation:	Virginia Secretary of State
Incorporation Date:	2018-01-11
Company Identification Number:	F208045
Legal Registered Office Address:	4701 Cox Rd Ste 285 Glen Allen United States of America (USA) 23060-6808