DPS LAND SERVICES, LLC HEALTH AND WELFARE PLAN 401k Plan overview
| Plan Name | DPS LAND SERVICES, LLC HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
DPS LAND SERVICES, LLC 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
- Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
|
401k Sponsoring company profile
DPS LAND SERVICES, LLC has sponsored the creation of one or more 401k plans.
| Company Name: | DPS LAND SERVICES, LLC |
| Employer identification number (EIN): | 800927914 |
| NAIC Classification: | 213110 |
| NAIC Description: | Support Activities for Mining |
Additional information about DPS LAND SERVICES, LLC
| Jurisdiction of Incorporation: | State of Delaware Division of Corporations |
| Incorporation Date: | 2014-10-07 |
| Company Identification Number: | 2333311 |
More information about DPS LAND SERVICES, LLC
Form 5500 Filing Information
Submission information for form 5500 for 401k plan DPS LAND SERVICES, LLC HEALTH AND WELFARE PLAN
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|
| 501 | 2019-07-01 | JUSTIN HOLLINGSWORTH | 2020-12-22 | | |
Plan Statistics for DPS LAND SERVICES, LLC HEALTH AND WELFARE PLAN
401k plan membership statisitcs for DPS LAND SERVICES, LLC HEALTH AND WELFARE PLAN
| Measure | Date | Value |
|---|
| 2019: DPS LAND SERVICES, LLC HEALTH AND WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 153 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 96 |
| Number of retired or separated participants receiving benefits | 2019-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-07-01 | 0 |
| Total of all active and inactive participants | 2019-07-01 | 96 |
| Number of employers contributing to the scheme | 2019-07-01 | 0 |
Form 5500 Responses for DPS LAND SERVICES, LLC HEALTH AND WELFARE PLAN
| 2019: DPS LAND SERVICES, LLC HEALTH AND WELFARE PLAN 2019 form 5500 responses |
|---|
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | First time form 5500 has been submitted | Yes |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
Insurance Providers Used on plan
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 918268 |
| Policy instance | 1 |
| Insurance contract or identification number | 918268 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $2,609 | | Total amount of fees paid to insurance company | USD $20,485 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $515,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,609 | | Amount paid for insurance broker fees | 20485 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT BONUS | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1113535 |
| Policy instance | 2 |
| Insurance contract or identification number | 1113535 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $2,970 | | Total amount of fees paid to insurance company | USD $2,485 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $25,654 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,970 | | Amount paid for insurance broker fees | 1694 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE EXPENSE BONUS | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3798634 |
| Policy instance | 3 |
| Insurance contract or identification number | E3798634 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $57 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $889 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 ) |
| Policy contract number | W2174 |
| Policy instance | 4 |
| Insurance contract or identification number | W2174 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $137 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,270 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $94 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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