| Plan Name | USA DOLLAR STORES INC HEALTH BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | USA DOLLAR STORES INC |
| Employer identification number (EIN): | 465215996 |
| NAIC Classification: | 541990 |
| NAIC Description: | All Other Professional, Scientific, and Technical Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-01-01 | ||||
| 501 | 2023-01-01 | SAUD SHAHRAM | |||
| 501 | 2022-01-01 | ||||
| 501 | 2022-01-01 | SAUD SHAHRAM | |||
| 501 | 2021-01-01 | ||||
| 501 | 2021-01-01 | SAUD SHAHRAM |
| 2023: USA DOLLAR STORES INC HEALTH BENEFIT PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: USA DOLLAR STORES INC HEALTH BENEFIT PLAN 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: USA DOLLAR STORES INC HEALTH BENEFIT PLAN 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | First time form 5500 has been submitted | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||
| Policy contract number | 1114581 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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| AXIS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 37273 ) | |||||||||||||||||||||||
| Policy contract number | 8032621 | ||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||
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| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||
| Policy contract number | 1114581 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| |||||||||||||||||||||||
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |||||||||||||||||||||||
| Policy contract number | 1114581 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||