401k Plan data: DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN plan

DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN
Plan identification number	501

DUBOW TEXTILE, INC. 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)

401k Sponsoring company profile

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

Company Name: DUBOW TEXTILE, INC.

Employer identification number (EIN): 411707831

NAIC Classification: 111100
NAIC Description: Oilseed and Grain Farming

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01
501 2021-01-01

Plan Statistics for DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2022: DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 171
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 183
Number of retired or separated participants receiving benefits 2022-01-01 1
Total of all active and inactive participants 2022-01-01 184
2021: DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 198
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 181
Total of all active and inactive participants 2021-01-01 181

Measure	Date	Value
2022: DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	171
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	183
Number of retired or separated participants receiving benefits	2022-01-01	1
Total of all active and inactive participants	2022-01-01	184
2021: DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	198
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	181
Total of all active and inactive participants	2021-01-01	181

Form 5500 Responses for DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN

2022: DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: DUBOW TEXTILE, INC. HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )

Policy contract number

23331

Policy instance

Insurance contract or identification number	23331
Number of Individuals Covered	137
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $20,536
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $453,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	13011
Additional information about fees paid to insurance broker	MARKETING ALLOWANCE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1088310

Policy instance

Insurance contract or identification number	1088310
Number of Individuals Covered	247
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $11,385
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $111,426
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,385
Insurance broker organization code?	3

HEALTHPARTNERS INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 44547 )

Policy contract number

23331

Policy instance

Insurance contract or identification number	23331
Number of Individuals Covered	123
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $18,685
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $434,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	16207
Additional information about fees paid to insurance broker	MARKETING ALLOWANCE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1088310

Policy instance

Insurance contract or identification number	1088310
Number of Individuals Covered	213
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,584
Total amount of fees paid to insurance company	USD $1,357
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $93,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,584
Insurance broker organization code?	3
Amount paid for insurance broker fees	1357
Additional information about fees paid to insurance broker	MARKETING ALLOWANCE

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Company Name:	DUBOW TEXTILE, INC.
Employer identification number (EIN):	411707831
NAIC Classification:	111100
NAIC Description:	Oilseed and Grain Farming