401k Plan data: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN plan

DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN
Plan identification number	501

DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover 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

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

Company Name: DASH AMERICA, INC.

Employer identification number (EIN): 841106355

NAIC Classification: 315990
NAIC Description: Apparel Accessories and Other Apparel Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01
501 2018-01-01 DEBRA KEZER
501 2017-01-01 DEBRA KEZER
501 2016-01-01 DEBRA KEZER
501 2015-01-01 DEBRA KEZER
501 2014-05-01 LAURA BUTLER
501 2013-05-01 LAURA BUTLER
501 2012-05-01 LILY C. FLORES
501 2011-05-01 LILY C. FLORES
501 2009-05-01 LILY FLORES

Plan Statistics for DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN

401k plan membership statisitcs for DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN

Measure Date Value
2019: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 80
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 81
2018: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 101
Number of retired or separated participants receiving benefits 2018-01-01 7
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 108
2017: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 135
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 107
Number of retired or separated participants receiving benefits 2017-01-01 4
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 111
2016: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 154
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 135
Number of retired or separated participants receiving benefits 2016-01-01 8
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 143
2015: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 148
Number of retired or separated participants receiving benefits 2015-01-01 3
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 151
2014: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-05-01 169
Total number of active participants reported on line 7a of the Form 5500 2014-05-01 145
Number of retired or separated participants receiving benefits 2014-05-01 5
Number of other retired or separated participants entitled to future benefits 2014-05-01 0
Total of all active and inactive participants 2014-05-01 150
2013: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-05-01 165
Total number of active participants reported on line 7a of the Form 5500 2013-05-01 161
Number of retired or separated participants receiving benefits 2013-05-01 14
Number of other retired or separated participants entitled to future benefits 2013-05-01 0
Total of all active and inactive participants 2013-05-01 175
2012: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-05-01 152
Total number of active participants reported on line 7a of the Form 5500 2012-05-01 141
Number of retired or separated participants receiving benefits 2012-05-01 20
Number of other retired or separated participants entitled to future benefits 2012-05-01 0
Total of all active and inactive participants 2012-05-01 161
2011: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-05-01 148
Total number of active participants reported on line 7a of the Form 5500 2011-05-01 149
Number of retired or separated participants receiving benefits 2011-05-01 2
Number of other retired or separated participants entitled to future benefits 2011-05-01 0
Total of all active and inactive participants 2011-05-01 151
2009: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-05-01 189
Total number of active participants reported on line 7a of the Form 5500 2009-05-01 204
Number of retired or separated participants receiving benefits 2009-05-01 0
Number of other retired or separated participants entitled to future benefits 2009-05-01 0
Total of all active and inactive participants 2009-05-01 204

Measure	Date	Value
2019: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	80
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	81
2018: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	101
Number of retired or separated participants receiving benefits	2018-01-01	7
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	108
2017: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	135
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	107
Number of retired or separated participants receiving benefits	2017-01-01	4
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	111
2016: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	135
Number of retired or separated participants receiving benefits	2016-01-01	8
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	143
2015: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	148
Number of retired or separated participants receiving benefits	2015-01-01	3
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	151
2014: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-05-01	169
Total number of active participants reported on line 7a of the Form 5500	2014-05-01	145
Number of retired or separated participants receiving benefits	2014-05-01	5
Number of other retired or separated participants entitled to future benefits	2014-05-01	0
Total of all active and inactive participants	2014-05-01	150
2013: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-05-01	165
Total number of active participants reported on line 7a of the Form 5500	2013-05-01	161
Number of retired or separated participants receiving benefits	2013-05-01	14
Number of other retired or separated participants entitled to future benefits	2013-05-01	0
Total of all active and inactive participants	2013-05-01	175
2012: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-05-01	152
Total number of active participants reported on line 7a of the Form 5500	2012-05-01	141
Number of retired or separated participants receiving benefits	2012-05-01	20
Number of other retired or separated participants entitled to future benefits	2012-05-01	0
Total of all active and inactive participants	2012-05-01	161
2011: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-05-01	148
Total number of active participants reported on line 7a of the Form 5500	2011-05-01	149
Number of retired or separated participants receiving benefits	2011-05-01	2
Number of other retired or separated participants entitled to future benefits	2011-05-01	0
Total of all active and inactive participants	2011-05-01	151
2009: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-05-01	189
Total number of active participants reported on line 7a of the Form 5500	2009-05-01	204
Number of retired or separated participants receiving benefits	2009-05-01	0
Number of other retired or separated participants entitled to future benefits	2009-05-01	0
Total of all active and inactive participants	2009-05-01	204

Form 5500 Responses for DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN

2019: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT 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: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT 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: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
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
2015: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2015 form 5500 responses
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: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-05-01	Type of plan entity	Single employer plan
2014-05-01	Submission has been amended	No
2014-05-01	This submission is the final filing	No
2014-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2014-05-01	Plan is a collectively bargained plan	No
2014-05-01	Plan funding arrangement – Insurance	Yes
2014-05-01	Plan benefit arrangement – Insurance	Yes
2013: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-05-01	Type of plan entity	Single employer plan
2013-05-01	Submission has been amended	No
2013-05-01	This submission is the final filing	No
2013-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-05-01	Plan is a collectively bargained plan	No
2013-05-01	Plan funding arrangement – Insurance	Yes
2013-05-01	Plan benefit arrangement – Insurance	Yes
2012: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-05-01	Type of plan entity	Single employer plan
2012-05-01	Submission has been amended	No
2012-05-01	This submission is the final filing	No
2012-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-05-01	Plan is a collectively bargained plan	No
2012-05-01	Plan funding arrangement – Insurance	Yes
2012-05-01	Plan benefit arrangement – Insurance	Yes
2011: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-05-01	Type of plan entity	Single employer plan
2011-05-01	Submission has been amended	No
2011-05-01	This submission is the final filing	No
2011-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-05-01	Plan is a collectively bargained plan	No
2011-05-01	Plan funding arrangement – Insurance	Yes
2011-05-01	Plan benefit arrangement – Insurance	Yes
2009: DASH AMERICA, INC. DBA PEARL IZUMI WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-05-01	Type of plan entity	Single employer plan
2009-05-01	Submission has been amended	No
2009-05-01	This submission is the final filing	No
2009-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-05-01	Plan is a collectively bargained plan	No
2009-05-01	Plan funding arrangement – Insurance	Yes
2009-05-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-05-01	Plan benefit arrangement – Insurance	Yes
2009-05-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	30080605
Policy instance	6
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400001000 13024
Policy instance	5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140173
Policy instance	4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140175
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140174
Policy instance	2
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	909912
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140174
Policy instance	2
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140175
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140173
Policy instance	4
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	30080605
Policy instance	6
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400001000 13024
Policy instance	5
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	909912
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140174
Policy instance	2
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140173
Policy instance	4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400001000 13024
Policy instance	5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140175
Policy instance	3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number	909912
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400001000 13024
Policy instance	5
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3334620
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140174
Policy instance	2
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140175
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140173
Policy instance	4
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3334620
Policy instance	1
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number	9865
Policy instance	2
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140174
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140173
Policy instance	5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400001000 13024
Policy instance	6
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140175
Policy instance	4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140174
Policy instance	3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	400001000 13024
Policy instance	6
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140173
Policy instance	5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140175
Policy instance	4
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number	9865
Policy instance	2
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3334620
Policy instance	1
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number	9865
Policy instance	2
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number	3334620
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140175
Policy instance	4
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140173
Policy instance	5
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140174
Policy instance	3
DELTA DENTAL OF COLORADO (National Association of Insurance Commissioners NAIC id number: 55875 )
Policy contract number	9865
Policy instance	3
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number	3334620
Policy instance	2
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140175
Policy instance	5
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	195348
Policy instance	1
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140173
Policy instance	6
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number	10140174
Policy instance	4
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	195348
Policy instance	1
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number	195348
Policy instance	2
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number	195348
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	LTD 117905
Policy instance	4
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL 144065
Policy instance	3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	G 159583
Policy instance	5
PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )
Policy contract number	10289
Policy instance	2
ROCKY MOUNTAIN HOSPITAL AND MEDICAL SERVICE, INC. (National Association of Insurance Commissioners NAIC id number: 11011 )
Policy contract number	195348
Policy instance	1
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	G 159583
Policy instance	5
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	LTD 117905
Policy instance	4
PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )
Policy contract number	10289
Policy instance	2
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number	GL 144065
Policy instance	3

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Company Name:	DASH AMERICA, INC.
Employer identification number (EIN):	841106355
NAIC Classification:	315990
NAIC Description:	Apparel Accessories and Other Apparel Manufacturing

Plan id#	Filing Submission Date	Name of Administrator
501	2019-01-01
501	2018-01-01	DEBRA KEZER
501	2017-01-01	DEBRA KEZER
501	2016-01-01	DEBRA KEZER
501	2015-01-01	DEBRA KEZER
501	2014-05-01	LAURA BUTLER
501	2013-05-01	LAURA BUTLER
501	2012-05-01	LILY C. FLORES
501	2011-05-01	LILY C. FLORES
501	2009-05-01	LILY FLORES