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NORTH DAVIS CABINET HEALTH & WELFARE PLAN 401k Plan overview

Plan NameNORTH DAVIS CABINET HEALTH & WELFARE PLAN
Plan identification number 501

NORTH DAVIS CABINET HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Long-term disability 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.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

NORTH DAVIS CABINET, INC has sponsored the creation of one or more 401k plans.

Company Name:NORTH DAVIS CABINET, INC
Employer identification number (EIN):870346402
NAIC Classification:339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH DAVIS CABINET HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-08-01CAMI RASSUMUSEN2023-11-06
5012021-08-01CAMI RASSUMUSEN2023-01-11
5012002-11-01CAMI RASSUMUSEN2023-01-11

Plan Statistics for NORTH DAVIS CABINET HEALTH & WELFARE PLAN

401k plan membership statisitcs for NORTH DAVIS CABINET HEALTH & WELFARE PLAN

Measure Date Value
2022: NORTH DAVIS CABINET HEALTH & WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-08-0198
Total number of active participants reported on line 7a of the Form 55002022-08-0197
Number of retired or separated participants receiving benefits2022-08-010
Number of other retired or separated participants entitled to future benefits2022-08-010
Total of all active and inactive participants2022-08-0197
Number of employers contributing to the scheme2022-08-010
2021: NORTH DAVIS CABINET HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-08-01104
Total number of active participants reported on line 7a of the Form 55002021-08-0197
Number of retired or separated participants receiving benefits2021-08-011
Number of other retired or separated participants entitled to future benefits2021-08-010
Total of all active and inactive participants2021-08-0198
Number of employers contributing to the scheme2021-08-010
2002: NORTH DAVIS CABINET HEALTH & WELFARE PLAN 2002 401k membership
Total participants, beginning-of-year2002-11-0147
Total number of active participants reported on line 7a of the Form 55002002-11-0157
Number of retired or separated participants receiving benefits2002-11-010
Number of other retired or separated participants entitled to future benefits2002-11-010
Total of all active and inactive participants2002-11-0157
Number of employers contributing to the scheme2002-11-010

Form 5500 Responses for NORTH DAVIS CABINET HEALTH & WELFARE PLAN

2022: NORTH DAVIS CABINET HEALTH & WELFARE PLAN 2022 form 5500 responses
2022-08-01Type of plan entitySingle employer plan
2022-08-01Plan funding arrangement – InsuranceYes
2022-08-01Plan funding arrangement – General assets of the sponsorYes
2022-08-01Plan benefit arrangement – InsuranceYes
2022-08-01Plan benefit arrangement – General assets of the sponsorYes
2021: NORTH DAVIS CABINET HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-08-01Type of plan entitySingle employer plan
2021-08-01Plan funding arrangement – InsuranceYes
2021-08-01Plan funding arrangement – General assets of the sponsorYes
2021-08-01Plan benefit arrangement – InsuranceYes
2021-08-01Plan benefit arrangement – General assets of the sponsorYes
2002: NORTH DAVIS CABINET HEALTH & WELFARE PLAN 2002 form 5500 responses
2002-11-01Type of plan entitySingle employer plan
2002-11-01Submission has been amendedYes
2002-11-01Plan funding arrangement – InsuranceYes
2002-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EDUCATORS MUTUAL PLANS LIFE, ACCIDENT AND HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 12515 )
Policy contract number2341
Policy instance 1
Insurance contract or identification number2341
Number of Individuals Covered227
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $2,821
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,821
Amount paid for insurance broker fees0
Insurance broker organization code?3
EDUCATORS MUTUAL PLANS LIFE, ACCIDENT AND HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 12515 )
Policy contract number2341
Policy instance 1
Insurance contract or identification number2341
Number of Individuals Covered237
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $2,997
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,997
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberG0000019604
Policy instance 1
Insurance contract or identification numberG0000019604
Number of Individuals Covered5
Insurance policy start date2002-11-01
Insurance policy end date2003-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number27971
Policy instance 2
Insurance contract or identification number27971
Number of Individuals Covered36
Insurance policy start date2002-11-01
Insurance policy end date2003-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $138,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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