401k Plan data: J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM plan

J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM 401k Plan overview

Plan Name	J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM
Plan identification number	513

J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Other welfare benefit cover

401k Sponsoring company profile

J. J. KELLER & ASSOCIATES, INC. has sponsored the creation of one or more 401k plans.

Company Name: J. J. KELLER & ASSOCIATES, INC.

Employer identification number (EIN): 390957377

NAIC Classification: 323100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
513 2021-01-01 DANA GILMAN 2022-06-03
513 2020-01-01
513 2020-01-01
513 2019-01-01

Plan Statistics for J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM

401k plan membership statisitcs for J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM

Measure Date Value
2021: J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1,587
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 0
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 0
Number of employers contributing to the scheme 2021-01-01 0
2020: J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1,495
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1,587
Total of all active and inactive participants 2020-01-01 1,587
Total participants 2020-01-01 1,587
2019: J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM 2019 401k membership
Total participants, beginning-of-year 2019-01-01 1,435
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 1,495
Total of all active and inactive participants 2019-01-01 1,495
Total participants 2019-01-01 1,495

Measure	Date	Value
2021: J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1,587
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	0
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	0
Number of employers contributing to the scheme	2021-01-01	0
2020: J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1,495
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1,587
Total of all active and inactive participants	2020-01-01	1,587
Total participants	2020-01-01	1,587
2019: J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM 2019 401k membership
Total participants, beginning-of-year	2019-01-01	1,435
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	1,495
Total of all active and inactive participants	2019-01-01	1,495
Total participants	2019-01-01	1,495

Form 5500 Responses for J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM

2021: J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	This submission is the final filing	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: J.J. KELLER & ASSOCIATES EMPLOYEE ASSISTANCE PROGRAM 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
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 – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

21258

Policy instance

Insurance contract or identification number	21258
Number of Individuals Covered	1776
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $35,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED BEHAVIORAL HEALTH DBA OPTUM (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

21258

Policy instance

Insurance contract or identification number	21258
Number of Individuals Covered	1587
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $30,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

J.J. KELLER FOUNDATION, INC. 403(B) [EIN = 391683437]

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Company Name:	J. J. KELLER & ASSOCIATES, INC.
Employer identification number (EIN):	390957377
NAIC Classification:	323100

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
513	2021-01-01	DANA GILMAN	2022-06-03
513	2020-01-01
513	2020-01-01
513	2019-01-01