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| Plan Name | S. J. INNOVATIONS, LLC HEALTH & WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | S.J. INNOVATIONS, LLC |
| Employer identification number (EIN): | 464317094 |
| NAIC Classification: | 541511 |
| NAIC Description: | Custom Computer Programming Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2017-09-01 | ||||
| 501 | 2016-09-01 | ||||
| 501 | 2016-02-01 | RALPH KUNKEL |
| Measure | Date | Value |
|---|---|---|
| 2017: S. J. INNOVATIONS, LLC HEALTH & WELFARE PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-09-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 113 |
| Number of retired or separated participants receiving benefits | 2017-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 1 |
| Total of all active and inactive participants | 2017-09-01 | 114 |
| 2016: S. J. INNOVATIONS, LLC HEALTH & WELFARE PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-09-01 | 90 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 96 |
| Number of retired or separated participants receiving benefits | 2016-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 1 |
| Total of all active and inactive participants | 2016-09-01 | 97 |
| Total participants, beginning-of-year | 2016-02-01 | 90 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 90 |
| Total of all active and inactive participants | 2016-02-01 | 90 |
| 2017: S. J. INNOVATIONS, LLC HEALTH & WELFARE PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Submission has been amended | No |
| 2017-09-01 | This submission is the final filing | No |
| 2017-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-09-01 | Plan is a collectively bargained plan | No |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: S. J. INNOVATIONS, LLC HEALTH & WELFARE PLAN 2016 form 5500 responses | ||
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Submission has been amended | No |
| 2016-09-01 | This submission is the final filing | No |
| 2016-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-09-01 | Plan is a collectively bargained plan | No |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | First time form 5500 has been submitted | Yes |
| 2016-02-01 | Submission has been amended | No |
| 2016-02-01 | This submission is the final filing | No |
| 2016-02-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2016-02-01 | Plan is a collectively bargained plan | No |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 3105 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 168023 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | F020255 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 30008967 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 4 | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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