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DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 401k Plan overview

Plan NameDSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN
Plan identification number 503

DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN Benefits

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

401k Sponsoring company profile

DSU-PETERBILT & GMC, INC. has sponsored the creation of one or more 401k plans.

Company Name:DSU-PETERBILT & GMC, INC.
Employer identification number (EIN):930507362
NAIC Classification:423100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032019-11-01
5032018-11-01
5032017-11-01
5032016-11-01JAMIE TOMAN JAMIE TOMAN2018-05-16
5032015-11-01JAMIE TOMAN
5032014-11-01JAMIE TOMAN
5032013-11-01JAMIE TOMAN
5032012-11-01PATRICK HOWARD PATRICK HOWARD2014-04-16
5032011-11-01PATRICK HOWARD
5032010-11-01PATRICK HOWARD

Plan Statistics for DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN

401k plan membership statisitcs for DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN

Measure Date Value
2019: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-01223
Total number of active participants reported on line 7a of the Form 55002019-11-01220
Number of retired or separated participants receiving benefits2019-11-013
Total of all active and inactive participants2019-11-01223
Total participants2019-11-01223
2018: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-01217
Total number of active participants reported on line 7a of the Form 55002018-11-01215
Number of retired or separated participants receiving benefits2018-11-012
Total of all active and inactive participants2018-11-01217
Total participants2018-11-01217
2017: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01205
Total number of active participants reported on line 7a of the Form 55002017-11-01215
Number of retired or separated participants receiving benefits2017-11-012
Total of all active and inactive participants2017-11-01217
Total participants2017-11-01217
2016: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01203
Total number of active participants reported on line 7a of the Form 55002016-11-01204
Number of retired or separated participants receiving benefits2016-11-011
Total of all active and inactive participants2016-11-01205
2015: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-01204
Total number of active participants reported on line 7a of the Form 55002015-11-01205
Number of retired or separated participants receiving benefits2015-11-013
Total of all active and inactive participants2015-11-01208
2014: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-01198
Total number of active participants reported on line 7a of the Form 55002014-11-01206
Number of retired or separated participants receiving benefits2014-11-010
Number of other retired or separated participants entitled to future benefits2014-11-010
Total of all active and inactive participants2014-11-01206
2013: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-01174
Total number of active participants reported on line 7a of the Form 55002013-11-01197
Number of retired or separated participants receiving benefits2013-11-010
Number of other retired or separated participants entitled to future benefits2013-11-010
Total of all active and inactive participants2013-11-01197
2012: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-11-01164
Total number of active participants reported on line 7a of the Form 55002012-11-01169
Number of retired or separated participants receiving benefits2012-11-013
Total of all active and inactive participants2012-11-01172
Total participants2012-11-01172
2011: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-11-01161
Total number of active participants reported on line 7a of the Form 55002011-11-01158
Number of retired or separated participants receiving benefits2011-11-013
Number of other retired or separated participants entitled to future benefits2011-11-010
Total of all active and inactive participants2011-11-01161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-11-010
2010: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-11-01160
Total number of active participants reported on line 7a of the Form 55002010-11-01152
Number of retired or separated participants receiving benefits2010-11-015
Total of all active and inactive participants2010-11-01157

Form 5500 Responses for DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN

2019: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Submission has been amendedNo
2019-11-01This submission is the final filingNo
2019-11-01This return/report is a short plan year return/report (less than 12 months)No
2019-11-01Plan is a collectively bargained planNo
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan funding arrangement – General assets of the sponsorYes
2019-11-01Plan benefit arrangement – InsuranceYes
2019-11-01Plan benefit arrangement – General assets of the sponsorYes
2018: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Submission has been amendedNo
2018-11-01This submission is the final filingNo
2018-11-01This return/report is a short plan year return/report (less than 12 months)No
2018-11-01Plan is a collectively bargained planNo
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan funding arrangement – General assets of the sponsorYes
2018-11-01Plan benefit arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – General assets of the sponsorYes
2017: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Submission has been amendedNo
2017-11-01This submission is the final filingNo
2017-11-01This return/report is a short plan year return/report (less than 12 months)No
2017-11-01Plan is a collectively bargained planNo
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan funding arrangement – General assets of the sponsorYes
2017-11-01Plan benefit arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – General assets of the sponsorYes
2016: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan funding arrangement – General assets of the sponsorYes
2016-11-01Plan benefit arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – General assets of the sponsorYes
2015: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan funding arrangement – General assets of the sponsorYes
2015-11-01Plan benefit arrangement – InsuranceYes
2015-11-01Plan benefit arrangement – General assets of the sponsorYes
2014: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan funding arrangement – General assets of the sponsorYes
2014-11-01Plan benefit arrangement – InsuranceYes
2014-11-01Plan benefit arrangement – General assets of the sponsorYes
2013: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan funding arrangement – General assets of the sponsorYes
2013-11-01Plan benefit arrangement – InsuranceYes
2013-11-01Plan benefit arrangement – General assets of the sponsorYes
2012: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan funding arrangement – General assets of the sponsorYes
2012-11-01Plan benefit arrangement – General assets of the sponsorYes
2011: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Submission has been amendedNo
2011-11-01This submission is the final filingNo
2011-11-01This return/report is a short plan year return/report (less than 12 months)No
2011-11-01Plan is a collectively bargained planNo
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan funding arrangement – General assets of the sponsorYes
2011-11-01Plan benefit arrangement – General assets of the sponsorYes
2010: DSU-PETERBILT & GMC INC HEALTH BENEFIT PLAN 2010 form 5500 responses
2010-11-01Type of plan entitySingle employer plan
2010-11-01Submission has been amendedNo
2010-11-01This submission is the final filingNo
2010-11-01This return/report is a short plan year return/report (less than 12 months)No
2010-11-01Plan is a collectively bargained planNo
2010-11-01Plan funding arrangement – InsuranceYes
2010-11-01Plan funding arrangement – General assets of the sponsorYes
2010-11-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number284739
Policy instance 1
Insurance contract or identification number284739
Number of Individuals Covered233
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $5,735
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $103,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,735
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number284739
Policy instance 2
Insurance contract or identification number284739
Number of Individuals Covered227
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $3,057
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $52,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,057
Amount paid for insurance broker fees0
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number406959
Policy instance 1
Insurance contract or identification number406959
Number of Individuals Covered494
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $43,781
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $437,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,781
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number284739
Policy instance 2
Insurance contract or identification number284739
Number of Individuals Covered71
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $3,476
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 CarrierUSD $50,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
OPTUMHEALTH (National Association of Insurance Commissioners NAIC id number: 41159 )
Policy contract numberUNI-202931
Policy instance 1
Insurance contract or identification numberUNI-202931
Number of Individuals Covered500
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $45,529
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $455,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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