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EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 401k Plan overview

Plan NameEMPLOYEE HEALTH PLAN OF THE JAN COMPANIES
Plan identification number 503

EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

THE JAN COMPANIES has sponsored the creation of one or more 401k plans.

Company Name:THE JAN COMPANIES
Employer identification number (EIN):050318793
NAIC Classification:722513
NAIC Description:Limited-Service Restaurants

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-05-01
5032021-05-01
5032020-05-01
5032019-05-01
5032018-05-01
5032017-05-01CYNTHIA SIMONSON
5032016-05-01CYNTHIA SIMONSON
5032015-07-01CYNTHIA SIMONSON

Plan Statistics for EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES

401k plan membership statisitcs for EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES

Measure Date Value
2022: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2022 401k membership
Total participants, beginning-of-year2022-05-012
Total number of active participants reported on line 7a of the Form 55002022-05-012
Number of retired or separated participants receiving benefits2022-05-010
Number of other retired or separated participants entitled to future benefits2022-05-010
Total of all active and inactive participants2022-05-012
2021: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2021 401k membership
Total participants, beginning-of-year2021-05-014
Total number of active participants reported on line 7a of the Form 55002021-05-012
Number of retired or separated participants receiving benefits2021-05-010
Number of other retired or separated participants entitled to future benefits2021-05-010
Total of all active and inactive participants2021-05-012
2020: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2020 401k membership
Total participants, beginning-of-year2020-05-016
Total number of active participants reported on line 7a of the Form 55002020-05-015
Number of retired or separated participants receiving benefits2020-05-010
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-015
2019: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2019 401k membership
Total participants, beginning-of-year2019-05-0112
Total number of active participants reported on line 7a of the Form 55002019-05-016
Number of retired or separated participants receiving benefits2019-05-010
Number of other retired or separated participants entitled to future benefits2019-05-010
Total of all active and inactive participants2019-05-016
2018: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2018 401k membership
Total participants, beginning-of-year2018-05-0110
Total number of active participants reported on line 7a of the Form 55002018-05-0112
Number of retired or separated participants receiving benefits2018-05-010
Number of other retired or separated participants entitled to future benefits2018-05-010
Total of all active and inactive participants2018-05-0112
2017: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2017 401k membership
Total participants, beginning-of-year2017-05-017
Total number of active participants reported on line 7a of the Form 55002017-05-0111
Number of retired or separated participants receiving benefits2017-05-010
Number of other retired or separated participants entitled to future benefits2017-05-010
Total of all active and inactive participants2017-05-0111
2016: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2016 401k membership
Total participants, beginning-of-year2016-05-017
Total number of active participants reported on line 7a of the Form 55002016-05-018
Number of retired or separated participants receiving benefits2016-05-010
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-018
2015: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2015 401k membership
Total participants, beginning-of-year2015-07-013
Total number of active participants reported on line 7a of the Form 55002015-07-015
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-015

Financial Data on EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES

Measure Date Value
2023 : EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2023 401k financial data
Total income from all sources2023-04-30$3,067
Expenses. Total of all expenses incurred2023-04-30$3,067
Benefits paid (including direct rollovers)2023-04-30$1,084
Value of fidelity bond covering the plan2023-04-30$2,000
Expenses. Other expenses not covered elsewhere2023-04-30$1,983
Net income (gross income less expenses)2023-04-30$0
Net plan assets at end of year (total assets less liabilities)2023-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2023-04-30$0
Total contributions received or receivable from employer(s)2023-04-30$3,067
2022 : EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2022 401k financial data
Total income from all sources2022-04-30$4,589
Expenses. Total of all expenses incurred2022-04-30$4,589
Benefits paid (including direct rollovers)2022-04-30$1,641
Value of fidelity bond covering the plan2022-04-30$1,000
Expenses. Other expenses not covered elsewhere2022-04-30$2,948
Net income (gross income less expenses)2022-04-30$0
Net plan assets at end of year (total assets less liabilities)2022-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2022-04-30$0
Total contributions received or receivable from employer(s)2022-04-30$4,589
2021 : EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2021 401k financial data
Total income from all sources2021-04-30$9,103
Expenses. Total of all expenses incurred2021-04-30$9,103
Benefits paid (including direct rollovers)2021-04-30$3,120
Total plan assets at beginning of year2021-04-30$0
Value of fidelity bond covering the plan2021-04-30$5,000
Expenses. Other expenses not covered elsewhere2021-04-30$5,983
Net income (gross income less expenses)2021-04-30$0
Net plan assets at end of year (total assets less liabilities)2021-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2021-04-30$0
Total contributions received or receivable from employer(s)2021-04-30$9,103
2020 : EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2020 401k financial data
Total plan liabilities at beginning of year2020-04-30$0
Total income from all sources2020-04-30$31,954
Expenses. Total of all expenses incurred2020-04-30$31,954
Benefits paid (including direct rollovers)2020-04-30$11,475
Total plan assets at end of year2020-04-30$0
Total plan assets at beginning of year2020-04-30$0
Value of fidelity bond covering the plan2020-04-30$5,000
Expenses. Other expenses not covered elsewhere2020-04-30$20,479
Net income (gross income less expenses)2020-04-30$0
Net plan assets at end of year (total assets less liabilities)2020-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2020-04-30$0
Total contributions received or receivable from employer(s)2020-04-30$31,954
2019 : EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2019 401k financial data
Total plan liabilities at end of year2019-04-30$0
Total plan liabilities at beginning of year2019-04-30$0
Total income from all sources2019-04-30$23,134
Expenses. Total of all expenses incurred2019-04-30$23,134
Benefits paid (including direct rollovers)2019-04-30$7,463
Total plan assets at end of year2019-04-30$0
Total plan assets at beginning of year2019-04-30$0
Value of fidelity bond covering the plan2019-04-30$5,000
Expenses. Other expenses not covered elsewhere2019-04-30$15,671
Net income (gross income less expenses)2019-04-30$0
Net plan assets at end of year (total assets less liabilities)2019-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2019-04-30$0
Total contributions received or receivable from employer(s)2019-04-30$23,134
2018 : EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2018 401k financial data
Total plan liabilities at end of year2018-04-30$0
Total plan liabilities at beginning of year2018-04-30$0
Total income from all sources2018-04-30$24,454
Expenses. Total of all expenses incurred2018-04-30$24,454
Benefits paid (including direct rollovers)2018-04-30$8,254
Total plan assets at end of year2018-04-30$0
Total plan assets at beginning of year2018-04-30$0
Value of fidelity bond covering the plan2018-04-30$5,000
Expenses. Other expenses not covered elsewhere2018-04-30$16,200
Net income (gross income less expenses)2018-04-30$0
Net plan assets at end of year (total assets less liabilities)2018-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2018-04-30$0
Total contributions received or receivable from employer(s)2018-04-30$24,454
2017 : EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2017 401k financial data
Total plan liabilities at end of year2017-04-30$0
Total plan liabilities at beginning of year2017-04-30$0
Total income from all sources2017-04-30$18,237
Expenses. Total of all expenses incurred2017-04-30$18,237
Benefits paid (including direct rollovers)2017-04-30$6,193
Total plan assets at end of year2017-04-30$0
Total plan assets at beginning of year2017-04-30$0
Value of fidelity bond covering the plan2017-04-30$5,000
Expenses. Other expenses not covered elsewhere2017-04-30$12,044
Net income (gross income less expenses)2017-04-30$0
Net plan assets at end of year (total assets less liabilities)2017-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2017-04-30$0
Total contributions received or receivable from employer(s)2017-04-30$18,237
2016 : EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2016 401k financial data
Total plan liabilities at end of year2016-04-30$0
Total plan liabilities at beginning of year2016-04-30$0
Total income from all sources2016-04-30$8,552
Expenses. Total of all expenses incurred2016-04-30$8,552
Benefits paid (including direct rollovers)2016-04-30$2,719
Total plan assets at end of year2016-04-30$0
Total plan assets at beginning of year2016-04-30$0
Value of fidelity bond covering the plan2016-04-30$5,000
Expenses. Other expenses not covered elsewhere2016-04-30$5,833
Net income (gross income less expenses)2016-04-30$0
Net plan assets at end of year (total assets less liabilities)2016-04-30$0
Net plan assets at beginning of year (total assets less liabilities)2016-04-30$0
Total contributions received or receivable from employer(s)2016-04-30$8,552

Form 5500 Responses for EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES

2022: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Submission has been amendedNo
2022-05-01This submission is the final filingNo
2022-05-01This return/report is a short plan year return/report (less than 12 months)No
2022-05-01Plan is a collectively bargained planNo
2022-05-01Plan funding arrangement – InsuranceYes
2022-05-01Plan funding arrangement – TrustYes
2022-05-01Plan benefit arrangement – InsuranceYes
2022-05-01Plan benefit arrangement - TrustYes
2021: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Submission has been amendedNo
2021-05-01This submission is the final filingNo
2021-05-01This return/report is a short plan year return/report (less than 12 months)No
2021-05-01Plan is a collectively bargained planNo
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan funding arrangement – TrustYes
2021-05-01Plan benefit arrangement – InsuranceYes
2021-05-01Plan benefit arrangement - TrustYes
2020: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Submission has been amendedNo
2020-05-01This submission is the final filingNo
2020-05-01This return/report is a short plan year return/report (less than 12 months)No
2020-05-01Plan is a collectively bargained planNo
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan funding arrangement – TrustYes
2020-05-01Plan benefit arrangement – InsuranceYes
2020-05-01Plan benefit arrangement - TrustYes
2019: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Submission has been amendedNo
2019-05-01This submission is the final filingNo
2019-05-01This return/report is a short plan year return/report (less than 12 months)No
2019-05-01Plan is a collectively bargained planNo
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan funding arrangement – TrustYes
2019-05-01Plan benefit arrangement – InsuranceYes
2019-05-01Plan benefit arrangement - TrustYes
2018: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Submission has been amendedNo
2018-05-01This submission is the final filingNo
2018-05-01This return/report is a short plan year return/report (less than 12 months)No
2018-05-01Plan is a collectively bargained planNo
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan funding arrangement – TrustYes
2018-05-01Plan benefit arrangement – InsuranceYes
2018-05-01Plan benefit arrangement - TrustYes
2017: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Submission has been amendedNo
2017-05-01This submission is the final filingNo
2017-05-01This return/report is a short plan year return/report (less than 12 months)No
2017-05-01Plan is a collectively bargained planNo
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan funding arrangement – TrustYes
2017-05-01Plan benefit arrangement – InsuranceYes
2017-05-01Plan benefit arrangement - TrustYes
2016: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan funding arrangement – TrustYes
2016-05-01Plan benefit arrangement – InsuranceYes
2016-05-01Plan benefit arrangement - TrustYes
2015: EMPLOYEE HEALTH PLAN OF THE JAN COMPANIES 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01First time form 5500 has been submittedYes
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number14438 NFA 0590
Policy instance 1
Insurance contract or identification number14438 NFA 0590
Number of Individuals Covered2
Insurance policy start date2022-05-01
Insurance policy end date2023-04-30
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 BenefitYes
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 $1,256
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number14438 NFA 0590
Policy instance 1
Insurance contract or identification number14438 NFA 0590
Number of Individuals Covered2
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
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 BenefitYes
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 $1,924
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number14438 NFA 0590
Policy instance 1
Insurance contract or identification number14438 NFA 0590
Number of Individuals Covered8
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
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 BenefitYes
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 $4,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number14438 NFA 0590
Policy instance 1
Insurance contract or identification number14438 NFA 0590
Number of Individuals Covered13
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
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 BenefitYes
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 $14,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number14438 NFA 0590
Policy instance 1
Insurance contract or identification number14438 NFA 0590
Number of Individuals Covered19
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
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 BenefitYes
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 $10,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number14438 NFA 0590
Policy instance 1
Insurance contract or identification number14438 NFA 0590
Number of Individuals Covered109115
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
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 $10,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NFA HEALTH PLUS INCORPORATED CELL (National Association of Insurance Commissioners NAIC id number: 0 )
Policy contract number14438 NFA 0673
Policy instance 1
Insurance contract or identification number14438 NFA 0673
Number of Individuals Covered12
Insurance policy start date2015-07-01
Insurance policy end date2016-04-30
Are there contracts with allocated funds for individual policies?No
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 $3,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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