401k Plan data: RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN plan

RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN 401k Plan overview

Plan Name	RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN
Plan identification number	507

RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	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

RJ PERSONNEL, INC DBA TEMP ASSOCIATES has sponsored the creation of one or more 401k plans.

Company Name: RJ PERSONNEL, INC DBA TEMP ASSOCIATES

Employer identification number (EIN): 421293379

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
507 2021-06-01 JAMARA RODRIGUEZ 2022-12-16
507 2021-06-01 JAMARA RODRIGUEZ 2023-10-20
507 2020-06-01 JAMARA RODRIGUEZ 2022-12-16

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
507	2021-06-01	JAMARA RODRIGUEZ	2022-12-16
507	2021-06-01	JAMARA RODRIGUEZ	2023-10-20
507	2020-06-01	JAMARA RODRIGUEZ	2022-12-16

Plan Statistics for RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN

401k plan membership statisitcs for RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN

Measure Date Value
2021: RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN 2021 401k membership
Total participants, beginning-of-year 2021-06-01 105
Total number of active participants reported on line 7a of the Form 5500 2021-06-01 86
Number of retired or separated participants receiving benefits 2021-06-01 0
Number of other retired or separated participants entitled to future benefits 2021-06-01 0
Total of all active and inactive participants 2021-06-01 86
2020: RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN 2020 401k membership
Total participants, beginning-of-year 2020-06-01 104
Total number of active participants reported on line 7a of the Form 5500 2020-06-01 109
Number of retired or separated participants receiving benefits 2020-06-01 0
Number of other retired or separated participants entitled to future benefits 2020-06-01 0
Total of all active and inactive participants 2020-06-01 109

Measure	Date	Value
2021: RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN 2021 401k membership
Total participants, beginning-of-year	2021-06-01	105
Total number of active participants reported on line 7a of the Form 5500	2021-06-01	86
Number of retired or separated participants receiving benefits	2021-06-01	0
Number of other retired or separated participants entitled to future benefits	2021-06-01	0
Total of all active and inactive participants	2021-06-01	86
2020: RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN 2020 401k membership
Total participants, beginning-of-year	2020-06-01	104
Total number of active participants reported on line 7a of the Form 5500	2020-06-01	109
Number of retired or separated participants receiving benefits	2020-06-01	0
Number of other retired or separated participants entitled to future benefits	2020-06-01	0
Total of all active and inactive participants	2020-06-01	109

Form 5500 Responses for RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN

2021: RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN 2021 form 5500 responses
2021-06-01	Type of plan entity	Single employer plan
2021-06-01	Submission has been amended	No
2021-06-01	This submission is the final filing	No
2021-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-06-01	Plan is a collectively bargained plan	No
2021-06-01	Plan funding arrangement – Insurance	Yes
2021-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-06-01	Plan benefit arrangement – Insurance	Yes
2021-06-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: RJ PERSONNEL, INC DBA TEMP ASSOCIATES VISION PLAN 2020 form 5500 responses
2020-06-01	Type of plan entity	Single employer plan
2020-06-01	First time form 5500 has been submitted	Yes
2020-06-01	Submission has been amended	No
2020-06-01	This submission is the final filing	No
2020-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-06-01	Plan is a collectively bargained plan	No
2020-06-01	Plan funding arrangement – Insurance	Yes
2020-06-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-06-01	Plan benefit arrangement – Insurance	Yes
2020-06-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

TA0003

Policy instance

Insurance contract or identification number	TA0003
Number of Individuals Covered	156
Insurance policy start date	2021-06-01
Insurance policy end date	2022-05-31
Total amount of commissions paid to insurance broker	USD $1,928
Total amount of fees paid to insurance company	USD $643
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 $11,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	643
Additional information about fees paid to insurance broker	MARKETING
Insurance broker organization code?	3

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

TA0003

Policy instance

Insurance contract or identification number	TA0003
Number of Individuals Covered	175
Insurance policy start date	2020-06-01
Insurance policy end date	2021-05-31
Total amount of commissions paid to insurance broker	USD $1,690
Total amount of fees paid to insurance company	USD $563
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 $12,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	563
Additional information about fees paid to insurance broker	MARKETING
Insurance broker organization code?	3

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Company Name:	RJ PERSONNEL, INC DBA TEMP ASSOCIATES
Employer identification number (EIN):	421293379
NAIC Classification:	238900