401k Plan data: DUO FORM PLASTICS HEALTH AND WELFARE PLAN plan

DUO FORM PLASTICS HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	DUO FORM PLASTICS HEALTH AND WELFARE PLAN
Plan identification number	505

DUO FORM PLASTICS HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

DUO-FORM ACQUISITION CORP. has sponsored the creation of one or more 401k plans.

Company Name: DUO-FORM ACQUISITION CORP.

Employer identification number (EIN): 383599750

NAIC Classification: 326100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DUO FORM PLASTICS HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2023-02-01 JULIANNE BILLINGTON 2024-07-31 JULIANNE BILLINGTON 2024-07-31
505 2022-02-01 JULIANNE BILLINGTON 2023-11-01 JULIANNE BILLINGTON 2023-11-01
505 2021-02-01 JULIANNE BILLINGTON 2022-08-29 JULIANNE BILLINGTON 2022-08-29
505 2020-02-01 LINDY LEHMAN 2021-11-12 LINDY LEHMAN 2021-11-12
505 2019-02-01 LINDY LEHMAN 2020-07-10 LINDY LEHMAN 2020-07-10
505 2018-02-01 JEFFERY MILLER 2019-08-16 JEFFERY MILLER 2019-08-16
505 2017-02-01
505 2016-02-01 JEFFREY MILLER
505 2015-02-01 JEFFERY MILLER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2023-02-01	JULIANNE BILLINGTON	2024-07-31	JULIANNE BILLINGTON	2024-07-31
505	2022-02-01	JULIANNE BILLINGTON	2023-11-01	JULIANNE BILLINGTON	2023-11-01
505	2021-02-01	JULIANNE BILLINGTON	2022-08-29	JULIANNE BILLINGTON	2022-08-29
505	2020-02-01	LINDY LEHMAN	2021-11-12	LINDY LEHMAN	2021-11-12
505	2019-02-01	LINDY LEHMAN	2020-07-10	LINDY LEHMAN	2020-07-10
505	2018-02-01	JEFFERY MILLER	2019-08-16	JEFFERY MILLER	2019-08-16
505	2017-02-01
505	2016-02-01	JEFFREY MILLER
505	2015-02-01	JEFFERY MILLER

Form 5500 Responses for DUO FORM PLASTICS HEALTH AND WELFARE PLAN

2023: DUO FORM PLASTICS HEALTH AND WELFARE PLAN 2023 form 5500 responses
2023-02-01	Type of plan entity	Single employer plan
2023-02-01	This submission is the final filing	Yes
2023-02-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2023-02-01	Plan funding arrangement – Insurance	Yes
2023-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-02-01	Plan benefit arrangement – Insurance	Yes
2023-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: DUO FORM PLASTICS HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-02-01	Type of plan entity	Single employer plan
2022-02-01	Plan funding arrangement – Insurance	Yes
2022-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-02-01	Plan benefit arrangement – Insurance	Yes
2022-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: DUO FORM PLASTICS HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-02-01	Type of plan entity	Single employer plan
2021-02-01	Plan funding arrangement – Insurance	Yes
2021-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-02-01	Plan benefit arrangement – Insurance	Yes
2021-02-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: DUO FORM PLASTICS HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-02-01	Type of plan entity	Single employer plan
2020-02-01	Plan funding arrangement – Insurance	Yes
2020-02-01	Plan benefit arrangement – Insurance	Yes
2019: DUO FORM PLASTICS HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-02-01	Type of plan entity	Single employer plan
2019-02-01	Submission has been amended	No
2019-02-01	This submission is the final filing	No
2019-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-02-01	Plan is a collectively bargained plan	No
2019-02-01	Plan funding arrangement – Insurance	Yes
2019-02-01	Plan benefit arrangement – Insurance	Yes
2018: DUO FORM PLASTICS HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-02-01	Type of plan entity	Single employer plan
2018-02-01	Submission has been amended	No
2018-02-01	This submission is the final filing	No
2018-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-02-01	Plan is a collectively bargained plan	No
2018-02-01	Plan funding arrangement – Insurance	Yes
2018-02-01	Plan benefit arrangement – Insurance	Yes
2017: DUO FORM PLASTICS HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-02-01	Type of plan entity	Single employer plan
2017-02-01	Plan funding arrangement – Insurance	Yes
2017-02-01	Plan benefit arrangement – Insurance	Yes
2016: DUO FORM PLASTICS HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-02-01	Type of plan entity	Single employer plan
2016-02-01	Submission has been amended	No
2016-02-01	This submission is the final filing	No
2016-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-02-01	Plan is a collectively bargained plan	No
2016-02-01	Plan funding arrangement – Insurance	Yes
2016-02-01	Plan benefit arrangement – Insurance	Yes
2015: DUO FORM PLASTICS HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-02-01	Type of plan entity	Single employer plan
2015-02-01	First time form 5500 has been submitted	Yes
2015-02-01	Submission has been amended	No
2015-02-01	This submission is the final filing	No
2015-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-02-01	Plan is a collectively bargained plan	No
2015-02-01	Plan funding arrangement – Insurance	Yes
2015-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0541800000

Policy instance

Insurance contract or identification number	0541800000
Number of Individuals Covered	38
Insurance policy start date	2023-02-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,495
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	CRITICAL HEALTH EVENTS
Welfare Benefit Premiums Paid to Carrier	USD $17,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 328859

Policy instance

Insurance contract or identification number	VPS 328859
Number of Individuals Covered	12
Insurance policy start date	2023-02-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,098
Total amount of fees paid to insurance company	USD $331
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 303634

Policy instance

Insurance contract or identification number	VPL 303634
Number of Individuals Covered	10
Insurance policy start date	2023-02-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $689
Total amount of fees paid to insurance company	USD $177
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 163797

Policy instance

Insurance contract or identification number	GL 163797
Number of Individuals Covered	171
Insurance policy start date	2023-02-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $3,865
Total amount of fees paid to insurance company	USD $1,242
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $19,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

253190483020

Policy instance

Insurance contract or identification number	253190483020
Number of Individuals Covered	385
Insurance policy start date	2023-02-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $8,700
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30024571 0002

Policy instance

Insurance contract or identification number	30024571 0002
Number of Individuals Covered	171
Insurance policy start date	2023-02-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,661
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30024571 0002

Policy instance

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

253190483020

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 163797

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 303634

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 328859

Policy instance

TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 )

Policy contract number

0541800000

Policy instance

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

253190483020

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 163797

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPL 303634

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 328859

Policy instance

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

281850

Policy instance

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

281850

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30024571 0002

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5942537

Policy instance

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

253190483020

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30024571 0002

Policy instance

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

281850

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5942537

Policy instance

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

253190483020

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30024571 0002

Policy instance

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

281850

Policy instance

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

281850

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30024571 0002

Policy instance

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

253190483020

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TS05942537

Policy instance

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

281850

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5942537

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

300245710003

Policy instance

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

253190483020

Policy instance

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

300245710003

Policy instance

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

281850

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10202100

Policy instance

HEALTH RESOURCES INC (National Association of Insurance Commissioners NAIC id number: 96887 )

Policy contract number

253190483020

Policy instance

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Company Name:	DUO-FORM ACQUISITION CORP.
Employer identification number (EIN):	383599750
NAIC Classification:	326100