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R & S HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameR & S HEALTH AND WELFARE PLAN
Plan identification number 515

R & S HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

DIXON-SHANE, LLC has sponsored the creation of one or more 401k plans.

Company Name:DIXON-SHANE, LLC
Employer identification number (EIN):331004627
NAIC Classification:325410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan R & S HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5152018-05-01MELISSA GARNER2019-11-25
5152017-05-01

Plan Statistics for R & S HEALTH AND WELFARE PLAN

401k plan membership statisitcs for R & S HEALTH AND WELFARE PLAN

Measure Date Value
2018: R & S HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-05-01295
Total number of active participants reported on line 7a of the Form 55002018-05-01277
Total of all active and inactive participants2018-05-01277
2017: R & S HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-01331
Total number of active participants reported on line 7a of the Form 55002017-05-01340
Total of all active and inactive participants2017-05-01340
Total participants2017-05-01340

Form 5500 Responses for R & S HEALTH AND WELFARE PLAN

2018: R & S HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – InsuranceYes
2017: R & S HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01First time form 5500 has been submittedYes
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD609562
Policy instance 7
Insurance contract or identification numberSGD609562
Number of Individuals Covered276
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $3,778
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,778
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberVDT602248
Policy instance 6
Insurance contract or identification numberVDT602248
Number of Individuals Covered120
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $2,486
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,711
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,486
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSOK606619
Policy instance 5
Insurance contract or identification numberSOK606619
Number of Individuals Covered277
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $643
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $6,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $643
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGM608952
Policy instance 4
Insurance contract or identification numberSGM608952
Number of Individuals Covered277
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $5,277
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY LIFE
Welfare Benefit Premiums Paid to CarrierUSD $52,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,277
Insurance broker organization code?3
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number27465
Policy instance 3
Insurance contract or identification number27465
Number of Individuals Covered123
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $14,547
Life Insurance Welfare BenefitYes
Other welfare benefits providedCANCER, CRITICAL ILLNESS, ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $48,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,709
Insurance broker organization code?3
DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )
Policy contract number0698640
Policy instance 2
Insurance contract or identification number0698640
Number of Individuals Covered386
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $6,249
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,249
Insurance broker organization code?3
ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )
Policy contract number00248862
Policy instance 1
Insurance contract or identification number00248862
Number of Individuals Covered439
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $45,504
Total amount of fees paid to insurance companyUSD $5,976
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,819,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,177
Insurance broker organization code?3
Amount paid for insurance broker fees5976
AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )
Policy contract number27465
Policy instance 4
Insurance contract or identification number27465
Number of Individuals Covered173
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $14,833
Other welfare benefits providedACCIDENT, CANCER, CI, UNIV LIFE
Welfare Benefit Premiums Paid to CarrierUSD $45,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,466
Insurance broker organization code?3
Insurance broker nameBENEFIT INSURANCE MARKETING
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number572172
Policy instance 3
Insurance contract or identification number572172
Number of Individuals Covered340
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $8,653
Total amount of fees paid to insurance companyUSD $722
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $83,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,653
Amount paid for insurance broker fees722
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameBENEFIT INSURANCE MARKETING
DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )
Policy contract number0698640
Policy instance 2
Insurance contract or identification number0698640
Number of Individuals Covered305
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $4,864
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,864
Insurance broker organization code?3
Insurance broker nameC LOUIS COCHRAN II
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number908225
Policy instance 1
Insurance contract or identification number908225
Number of Individuals Covered393
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $47,784
Total amount of fees paid to insurance companyUSD $5,730
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,538,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,784
Amount paid for insurance broker fees5730
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameBENEFIT INSURANCE MARKETING, INC.

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