401k Plan data: 502 DENTAL STD LTD LIFE plan

502 DENTAL STD LTD LIFE 401k Plan overview

Plan Name	502 DENTAL STD LTD LIFE
Plan identification number	502

502 DENTAL STD LTD LIFE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Dental Temporary disability (accident and sickness) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

DENALI SOURCING SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: DENALI SOURCING SERVICES, INC.

Employer identification number (EIN): 263816679

NAIC Classification: 541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 502 DENTAL STD LTD LIFE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2017-10-01
502 2016-10-01
502 2015-10-01 LESA KELLER LESA KELLER 2017-10-23
502 2015-10-01 LESA KELLER 2017-07-27
502 2015-01-01 LESA KELLER LESA KELLER 2017-06-30
502 2014-10-01 LESA KELLER LESA KELLER 2016-04-26

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2017-10-01
502	2016-10-01
502	2015-10-01	LESA KELLER	LESA KELLER	2017-10-23
502	2015-10-01		LESA KELLER	2017-07-27
502	2015-01-01	LESA KELLER	LESA KELLER	2017-06-30
502	2014-10-01	LESA KELLER	LESA KELLER	2016-04-26

Plan Statistics for 502 DENTAL STD LTD LIFE

401k plan membership statisitcs for 502 DENTAL STD LTD LIFE

Measure Date Value
2017: 502 DENTAL STD LTD LIFE 2017 401k membership
Total participants, beginning-of-year 2017-10-01 153
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 0
Number of retired or separated participants receiving benefits 2017-10-01 0
Number of other retired or separated participants entitled to future benefits 2017-10-01 0
Total of all active and inactive participants 2017-10-01 0
2016: 502 DENTAL STD LTD LIFE 2016 401k membership
Total participants, beginning-of-year 2016-10-01 150
Total number of active participants reported on line 7a of the Form 5500 2016-10-01 153
Number of retired or separated participants receiving benefits 2016-10-01 0
Number of other retired or separated participants entitled to future benefits 2016-10-01 0
Total of all active and inactive participants 2016-10-01 153
2015: 502 DENTAL STD LTD LIFE 2015 401k membership
Total participants, beginning-of-year 2015-10-01 148
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 150
Number of retired or separated participants receiving benefits 2015-10-01 0
Number of other retired or separated participants entitled to future benefits 2015-10-01 0
Total of all active and inactive participants 2015-10-01 150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-10-01 0
Total participants 2015-10-01 150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-10-01 0
Total participants, beginning-of-year 2015-01-01 148
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 150
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: 502 DENTAL STD LTD LIFE 2014 401k membership
Total participants, beginning-of-year 2014-10-01 97
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 148
Number of retired or separated participants receiving benefits 2014-10-01 0
Number of other retired or separated participants entitled to future benefits 2014-10-01 0
Total of all active and inactive participants 2014-10-01 148
Total participants 2014-10-01 148
Number of participants with account balances 2014-10-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-10-01 0

Measure	Date	Value
2017: 502 DENTAL STD LTD LIFE 2017 401k membership
Total participants, beginning-of-year	2017-10-01	153
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	0
Number of retired or separated participants receiving benefits	2017-10-01	0
Number of other retired or separated participants entitled to future benefits	2017-10-01	0
Total of all active and inactive participants	2017-10-01	0
2016: 502 DENTAL STD LTD LIFE 2016 401k membership
Total participants, beginning-of-year	2016-10-01	150
Total number of active participants reported on line 7a of the Form 5500	2016-10-01	153
Number of retired or separated participants receiving benefits	2016-10-01	0
Number of other retired or separated participants entitled to future benefits	2016-10-01	0
Total of all active and inactive participants	2016-10-01	153
2015: 502 DENTAL STD LTD LIFE 2015 401k membership
Total participants, beginning-of-year	2015-10-01	148
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	150
Number of retired or separated participants receiving benefits	2015-10-01	0
Number of other retired or separated participants entitled to future benefits	2015-10-01	0
Total of all active and inactive participants	2015-10-01	150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-10-01	0
Total participants	2015-10-01	150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-10-01	0
Total participants, beginning-of-year	2015-01-01	148
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	150
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: 502 DENTAL STD LTD LIFE 2014 401k membership
Total participants, beginning-of-year	2014-10-01	97
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	148
Number of retired or separated participants receiving benefits	2014-10-01	0
Number of other retired or separated participants entitled to future benefits	2014-10-01	0
Total of all active and inactive participants	2014-10-01	148
Total participants	2014-10-01	148
Number of participants with account balances	2014-10-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-10-01	0

Form 5500 Responses for 502 DENTAL STD LTD LIFE

2017: 502 DENTAL STD LTD LIFE 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Submission has been amended	No
2017-10-01	This submission is the final filing	Yes
2017-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-10-01	Plan is a collectively bargained plan	No
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2016: 502 DENTAL STD LTD LIFE 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2015: 502 DENTAL STD LTD LIFE 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	Yes
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: 502 DENTAL STD LTD LIFE 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	First time form 5500 has been submitted	Yes
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00468041

Policy instance

Insurance contract or identification number	00468041
Number of Individuals Covered	191
Insurance policy start date	2017-10-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,896
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $26,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,896
Insurance broker organization code?	3
Insurance broker name	THE HDH GROUP

Potentially related plans

502 DENTAL STD LTD LIFE [EIN = 811003694]

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Company Name:	DENALI SOURCING SERVICES, INC.
Employer identification number (EIN):	263816679
NAIC Classification:	541600