401k Plan data: ELDER JONES HEALTH AND WELFARE BENEFITS PLAN plan

ELDER JONES HEALTH AND WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	ELDER JONES HEALTH AND WELFARE BENEFITS PLAN
Plan identification number	501

ELDER JONES HEALTH AND WELFARE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Other welfare benefit cover

401k Sponsoring company profile

ELDER-JONES, INC. has sponsored the creation of one or more 401k plans.

Company Name: ELDER-JONES, INC.

Employer identification number (EIN): 410974888

NAIC Classification: 561790
NAIC Description: Other Services to Buildings and Dwellings

Additional information about ELDER-JONES, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 1982-01-04

Company Identification Number: 0005337706

Legal Registered Office Address: 1120 E 80TH ST STE 102

MINNEAPOLIS
United States of America (USA)
55420

More information about ELDER-JONES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ELDER JONES HEALTH AND WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01

Plan Statistics for ELDER JONES HEALTH AND WELFARE BENEFITS PLAN

401k plan membership statisitcs for ELDER JONES HEALTH AND WELFARE BENEFITS PLAN

Measure Date Value
2023: ELDER JONES HEALTH AND WELFARE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 108
Number of retired or separated participants receiving benefits 2023-01-01 3
Total of all active and inactive participants 2023-01-01 111
Total participants 2023-01-01 111

Measure	Date	Value
2023: ELDER JONES HEALTH AND WELFARE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	108
Number of retired or separated participants receiving benefits	2023-01-01	3
Total of all active and inactive participants	2023-01-01	111
Total participants	2023-01-01	111

Form 5500 Responses for ELDER JONES HEALTH AND WELFARE BENEFITS PLAN

2023: ELDER JONES HEALTH AND WELFARE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BANNER HEALTH AND AETNA HEALTH (National Association of Insurance Commissioners NAIC id number: 16058 )

Policy contract number

176039

Policy instance

Insurance contract or identification number	176039
Number of Individuals Covered	81
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $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 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	Yes
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

30912-1184

Policy instance

Insurance contract or identification number	30912-1184
Number of Individuals Covered	107
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $715
Total amount of fees paid to insurance company	USD $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 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	Yes
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 $6,881
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05934048

Policy instance

Insurance contract or identification number	KM05934048
Number of Individuals Covered	261
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $14,871
Total amount of fees paid to insurance company	USD $832
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	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&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 Carrier	USD $139,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ELDER-JONES, INC.
Employer identification number (EIN):	410974888
NAIC Classification:	561790
NAIC Description:	Other Services to Buildings and Dwellings

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	1982-01-04
Company Identification Number:	0005337706
Legal Registered Office Address:	1120 E 80TH ST STE 102 MINNEAPOLIS United States of America (USA) 55420