DORMAN CONSTRUCTION HEALTH & WELFARE BENEFIT PLAN 401k Plan overview
| Plan Name | DORMAN CONSTRUCTION HEALTH & WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
DORMAN CONSTRUCTION HEALTH & WELFARE BENEFIT PLAN Benefits
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits | - Health (other than dental or vision)
- Dental
- Vision
- 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
DORMAN CONSTRUCTION, INC. has sponsored the creation of one or more 401k plans.
Additional information about DORMAN CONSTRUCTION, INC.
| Jurisdiction of Incorporation: | Oregon Secretary of State Corporations Division |
| Incorporation Date: | 1990-08-13 |
| Company Identification Number: | 21400189 |
| Legal Registered Office Address: |
303 SO 5TH ST STE 135
SPRINGFIELD
United States of America (USA)
97477
|
More information about DORMAN CONSTRUCTION, INC.
Form 5500 Filing Information
Submission information for form 5500 for 401k plan DORMAN CONSTRUCTION HEALTH & WELFARE BENEFIT PLAN
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|
| 501 | 2021-01-01 | MARCIA FORSHEE | 2022-06-13 | | |
Plan Statistics for DORMAN CONSTRUCTION HEALTH & WELFARE BENEFIT PLAN
401k plan membership statisitcs for DORMAN CONSTRUCTION HEALTH & WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2021: DORMAN CONSTRUCTION HEALTH & WELFARE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 98 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 98 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
Form 5500 Responses for DORMAN CONSTRUCTION HEALTH & WELFARE BENEFIT PLAN
| 2021: DORMAN CONSTRUCTION HEALTH & WELFARE 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 benefit arrangement – Insurance | Yes |
Insurance Providers Used on plan
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 10041757 |
| Policy instance | 1 |
| Insurance contract or identification number | 10041757 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $26,841 | | Total amount of fees paid to insurance company | USD $1,610 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $760,300 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,785 | | Amount paid for insurance broker fees | 1610 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1135204 |
| Policy instance | 2 |
| Insurance contract or identification number | 1135204 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,714 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,744 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
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