401k Plan data: ROADEX AMERICA HEALTH AND WELFARE BENEFITS PLAN plan

ROADEX AMERICA HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	ROADEX AMERICA HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	501

ROADEX AMERICA HEALTH AND WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

ROADEX AMERICA, INC. has sponsored the creation of one or more 401k plans.

Company Name: ROADEX AMERICA, INC.

Employer identification number (EIN): 954873964

NAIC Classification: 488510
NAIC Description: Freight Transportation Arrangement

Additional information about ROADEX AMERICA, INC.

Jurisdiction of Incorporation: California Department of State

Incorporation Date: 2001-07-25

Company Identification Number: C2317245

Legal Registered Office Address: 1515 W. 178th Street

Gardena
United States of America (USA)
90248

More information about ROADEX AMERICA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROADEX AMERICA HEALTH AND WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-12-01 ISAAC ALCALA 2023-05-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2021-12-01	ISAAC ALCALA	2023-05-16

Plan Statistics for ROADEX AMERICA HEALTH AND WELFARE BENEFITS PLAN

401k plan membership statisitcs for ROADEX AMERICA HEALTH AND WELFARE BENEFITS PLAN

Measure Date Value
2021: ROADEX AMERICA HEALTH AND WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-12-01 100
Total number of active participants reported on line 7a of the Form 5500 2021-12-01 178
Number of retired or separated participants receiving benefits 2021-12-01 0
Number of other retired or separated participants entitled to future benefits 2021-12-01 0
Total of all active and inactive participants 2021-12-01 178
Number of employers contributing to the scheme 2021-12-01 0

Measure	Date	Value
2021: ROADEX AMERICA HEALTH AND WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-12-01	100
Total number of active participants reported on line 7a of the Form 5500	2021-12-01	178
Number of retired or separated participants receiving benefits	2021-12-01	0
Number of other retired or separated participants entitled to future benefits	2021-12-01	0
Total of all active and inactive participants	2021-12-01	178
Number of employers contributing to the scheme	2021-12-01	0

Form 5500 Responses for ROADEX AMERICA HEALTH AND WELFARE BENEFITS PLAN

2021: ROADEX AMERICA HEALTH AND WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-12-01	Type of plan entity	Single employer plan
2021-12-01	First time form 5500 has been submitted	Yes
2021-12-01	Plan funding arrangement – Insurance	Yes
2021-12-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

19200

Policy instance

Insurance contract or identification number	19200
Number of Individuals Covered	183
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $7,536
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $75,355
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $6,951
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12278409

Policy instance

Insurance contract or identification number	12278409
Number of Individuals Covered	109
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $1,505
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,505
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

232910

Policy instance

Insurance contract or identification number	232910
Number of Individuals Covered	164
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $53,185
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $1,098,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,510
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

951894

Policy instance

Insurance contract or identification number	951894
Number of Individuals Covered	178
Insurance policy start date	2021-12-01
Insurance policy end date	2022-11-30
Total amount of commissions paid to insurance broker	USD $2,679
Total amount of fees paid to insurance company	USD $178
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $21,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,473
Amount paid for insurance broker fees	178
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

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Company Name:	ROADEX AMERICA, INC.
Employer identification number (EIN):	954873964
NAIC Classification:	488510
NAIC Description:	Freight Transportation Arrangement

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:	2001-07-25
Company Identification Number:	C2317245
Legal Registered Office Address:	1515 W. 178th Street Gardena United States of America (USA) 90248