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| Plan Name | DSS FIRE, INC. CAFETERIA PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | DSS FIRE, INC. |
| Employer identification number (EIN): | 752178377 |
| NAIC Classification: | 238210 |
| NAIC Description: | Electrical Contractors and Other Wiring Installation Contractors |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2018-01-01 | ||||
| 501 | 2017-01-01 | JOHN COULSON | JOHN COULSON | 2018-10-12 | |
| 501 | 2016-01-01 | JOHN COULSON |
| Measure | Date | Value |
|---|---|---|
| 2018: DSS FIRE, INC. CAFETERIA PLAN 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 96 |
| Total of all active and inactive participants | 2018-01-01 | 96 |
| Total participants | 2018-01-01 | 96 |
| 2017: DSS FIRE, INC. CAFETERIA PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 107 |
| Total of all active and inactive participants | 2017-01-01 | 107 |
| Total participants | 2017-01-01 | 107 |
| 2016: DSS FIRE, INC. CAFETERIA PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-01-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 107 |
| Total of all active and inactive participants | 2016-01-01 | 107 |
| Total participants | 2016-01-01 | 107 |
| 2018: DSS FIRE, INC. CAFETERIA PLAN 2018 form 5500 responses | ||
|---|---|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: DSS FIRE, INC. CAFETERIA PLAN 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: DSS FIRE, INC. CAFETERIA PLAN 2016 form 5500 responses | ||
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | First time form 5500 has been submitted | Yes |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| S & W HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95099 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | XCLR182J/CLR182 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0869366 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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