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CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 401k Plan overview

Plan NameCJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO
Plan identification number 501

CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Dental

401k Sponsoring company profile

CJSD HOLDINGS, INC. has sponsored the creation of one or more 401k plans.

Company Name:CJSD HOLDINGS, INC.
Employer identification number (EIN):205876029
NAIC Classification:445120
NAIC Description:Convenience Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01LESLEY SEGADELLI2024-10-09
5012022-01-01LESLEY SEGADELLI
5012021-01-01LESLEY SEGADELLI2022-07-21
5012020-01-01SANDY BOLINSKE2021-06-28
5012019-01-01SANDY BOLINSKE2020-07-29
5012018-01-01SANDY BOLINSKE2019-06-17
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01LOU ALDECOA
5012011-01-01LOU ALDECOA
5012009-01-01LOU ALDECOA
5012009-01-01LOU ALDECOA

Plan Statistics for CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO

401k plan membership statisitcs for CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO

Measure Date Value
2023: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2023 401k membership
Total participants, beginning-of-year2023-01-01350
Total number of active participants reported on line 7a of the Form 55002023-01-01416
Total of all active and inactive participants2023-01-01416
2022: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2022 401k membership
Total participants, beginning-of-year2022-01-01306
Total number of active participants reported on line 7a of the Form 55002022-01-01350
Total of all active and inactive participants2022-01-01350
2021: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2021 401k membership
Total participants, beginning-of-year2021-01-01321
Total number of active participants reported on line 7a of the Form 55002021-01-01306
Total of all active and inactive participants2021-01-01306
2020: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2020 401k membership
Total participants, beginning-of-year2020-01-01349
Total number of active participants reported on line 7a of the Form 55002020-01-01321
Total of all active and inactive participants2020-01-01321
2019: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2019 401k membership
Total participants, beginning-of-year2019-01-01352
Total number of active participants reported on line 7a of the Form 55002019-01-01349
Total of all active and inactive participants2019-01-01349
2018: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2018 401k membership
Total participants, beginning-of-year2018-01-01297
Total number of active participants reported on line 7a of the Form 55002018-01-01352
Total of all active and inactive participants2018-01-01352
2017: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2017 401k membership
Total participants, beginning-of-year2017-01-01310
Total number of active participants reported on line 7a of the Form 55002017-01-01297
Total of all active and inactive participants2017-01-01297
2016: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2016 401k membership
Total participants, beginning-of-year2016-01-01270
Total number of active participants reported on line 7a of the Form 55002016-01-01310
Total of all active and inactive participants2016-01-01310
2015: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2015 401k membership
Total participants, beginning-of-year2015-01-01256
Total number of active participants reported on line 7a of the Form 55002015-01-01270
Total of all active and inactive participants2015-01-01270
2014: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2014 401k membership
Total participants, beginning-of-year2014-01-01210
Total number of active participants reported on line 7a of the Form 55002014-01-01256
Total of all active and inactive participants2014-01-01256
2013: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2013 401k membership
Total participants, beginning-of-year2013-01-01199
Total number of active participants reported on line 7a of the Form 55002013-01-01210
Total of all active and inactive participants2013-01-01210
2012: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2012 401k membership
Total participants, beginning-of-year2012-01-01179
Total number of active participants reported on line 7a of the Form 55002012-01-01199
Total of all active and inactive participants2012-01-01199
2011: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2011 401k membership
Total participants, beginning-of-year2011-01-01163
Total number of active participants reported on line 7a of the Form 55002011-01-01179
Total of all active and inactive participants2011-01-01179
2009: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2009 401k membership
Total participants, beginning-of-year2009-01-01173
Total number of active participants reported on line 7a of the Form 55002009-01-01165
Total of all active and inactive participants2009-01-01165

Form 5500 Responses for CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO

2023: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2013 form 5500 responses
2013-01-01Type of plan entityMulitple employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2012 form 5500 responses
2012-01-01Type of plan entityMulitple employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2011 form 5500 responses
2011-01-01Type of plan entityMulitple employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: CJSD HOLDINGS INC DENTAL PLAN ADMIN THROUGH DELTA DENTAL OF IDAHO 2009 form 5500 responses
2009-01-01Type of plan entityMulitple employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 )
Policy contract number1483
Policy instance 1
Insurance contract or identification number1483
Number of Individuals Covered416
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $3,406
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $170,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 )
Policy contract number1483
Policy instance 1
Insurance contract or identification number1483
Number of Individuals Covered350
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,079
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $153,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,079
Insurance broker organization code?3
DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 )
Policy contract number1483
Policy instance 1
Insurance contract or identification number1483
Number of Individuals Covered306
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,120
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $155,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,120
Insurance broker organization code?3
DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 )
Policy contract number1483
Policy instance 1
Insurance contract or identification number1483
Number of Individuals Covered321
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,724
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $136,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,724
Insurance broker organization code?3
DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 )
Policy contract number1483
Policy instance 1
Insurance contract or identification number1483
Number of Individuals Covered349
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,510
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $175,490
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,510
Insurance broker organization code?3
DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 )
Policy contract number1483
Policy instance 1
Insurance contract or identification number1483
Number of Individuals Covered352
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,023
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $201,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,023
Insurance broker organization code?3
DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 )
Policy contract number1483
Policy instance 1
Insurance contract or identification number1483
Number of Individuals Covered297
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,282
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $164,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,282
Insurance broker organization code?3
Insurance broker nameFREDRIKSEN BROWN INSURANCE

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