401k Plan data: DYNAMIC STRUCTURES INC. HEALTH AND WELFARE PLAN plan

DYNAMIC STRUCTURES INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	DYNAMIC STRUCTURES INC. HEALTH AND WELFARE PLAN
Plan identification number	501

DYNAMIC STRUCTURES INC. HEALTH AND WELFARE 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) 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

DYNAMIC STRUCTURES INC. has sponsored the creation of one or more 401k plans.

Company Name: DYNAMIC STRUCTURES INC.

Employer identification number (EIN): 341802464

NAIC Classification: 213110
NAIC Description: Support Activities for Mining

Additional information about DYNAMIC STRUCTURES INC.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 2004-05-18

Company Identification Number: 3054979

Legal Registered Office Address: 733 YONKERS AVE STE 303
Westchester
YONKERS
United States of America (USA)
10704

More information about DYNAMIC STRUCTURES INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DYNAMIC STRUCTURES INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-06-01 JENNIFER L MILLER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2015-06-01	JENNIFER L MILLER

Plan Statistics for DYNAMIC STRUCTURES INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for DYNAMIC STRUCTURES INC. HEALTH AND WELFARE PLAN

Measure Date Value
2015: DYNAMIC STRUCTURES INC. HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-06-01 127
Total number of active participants reported on line 7a of the Form 5500 2015-06-01 55
Number of retired or separated participants receiving benefits 2015-06-01 0
Number of other retired or separated participants entitled to future benefits 2015-06-01 0
Total of all active and inactive participants 2015-06-01 55

Measure	Date	Value
2015: DYNAMIC STRUCTURES INC. HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-06-01	127
Total number of active participants reported on line 7a of the Form 5500	2015-06-01	55
Number of retired or separated participants receiving benefits	2015-06-01	0
Number of other retired or separated participants entitled to future benefits	2015-06-01	0
Total of all active and inactive participants	2015-06-01	55

Form 5500 Responses for DYNAMIC STRUCTURES INC. HEALTH AND WELFARE PLAN

2015: DYNAMIC STRUCTURES INC. HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	First time form 5500 has been submitted	Yes
2015-06-01	Submission has been amended	No
2015-06-01	This submission is the final filing	No
2015-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-06-01	Plan is a collectively bargained plan	No
2015-06-01	Plan funding arrangement – Insurance	Yes
2015-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

233470/618424

Policy instance

Insurance contract or identification number	233470/618424
Number of Individuals Covered	39
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $17,378
Total amount of fees paid to insurance company	USD $490
Are there contracts with allocated funds for individual policies?	No
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	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 $528,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,378
Amount paid for insurance broker fees	490
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	ASSURED NEACE LUKENS INS. AGENCY

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

233470

Policy instance

Insurance contract or identification number	233470
Number of Individuals Covered	55
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31
Total amount of commissions paid to insurance broker	USD $640
Total amount of fees paid to insurance company	USD $249
Are there contracts with allocated funds for individual policies?	No
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	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
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 $5,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $640
Amount paid for insurance broker fees	249
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	ASSURED NEACE LUKENS INS. AGENCY

Potentially related plans

DYNAMIC STRUCTURES, INC. RETIREMENT PLAN [EIN = 020723935]

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Company Name:	DYNAMIC STRUCTURES INC.
Employer identification number (EIN):	341802464
NAIC Classification:	213110
NAIC Description:	Support Activities for Mining

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	2004-05-18
Company Identification Number:	3054979
Legal Registered Office Address:	733 YONKERS AVE STE 303 Westchester YONKERS United States of America (USA) 10704