401k Plan data: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN plan

JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 401k Plan overview

Plan Name	JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN
Plan identification number	501

JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision Prepaid legal Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

JACKSON ENERGY COOPERATIVE has sponsored the creation of one or more 401k plans.

Company Name: JACKSON ENERGY COOPERATIVE

Employer identification number (EIN): 610236351

NAIC Classification: 221500

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 KATIE DOTSON 2024-10-03
501 2018-01-01 KATIE DOTSON
501 2017-01-01 KATIE DOTSON
501 2016-01-01 KATIE DOTSON
501 2015-01-01 KATIE DOTSON
501 2014-01-01 KATIE DOTSON
501 2013-01-01 KATIE DOTSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	KATIE DOTSON	2024-10-03
501	2018-01-01	KATIE DOTSON
501	2017-01-01	KATIE DOTSON
501	2016-01-01	KATIE DOTSON
501	2015-01-01	KATIE DOTSON
501	2014-01-01	KATIE DOTSON
501	2013-01-01	KATIE DOTSON

Plan Statistics for JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN

401k plan membership statisitcs for JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN

Measure Date Value
2023: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 99
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 105
Number of retired or separated participants receiving benefits 2023-01-01 47
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 152
Number of employers contributing to the scheme 2023-01-01 0
2018: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 119
Number of retired or separated participants receiving benefits 2018-01-01 17
Number of other retired or separated participants entitled to future benefits 2018-01-01 4
Total of all active and inactive participants 2018-01-01 140
2017: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 118
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 4
Total of all active and inactive participants 2017-01-01 122
2016: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 119
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 3
Total of all active and inactive participants 2016-01-01 122
2015: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 122
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 149
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 13
Total of all active and inactive participants 2015-01-01 162
2014: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 121
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 121
2013: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 133
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 133

Measure	Date	Value
2023: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	99
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	105
Number of retired or separated participants receiving benefits	2023-01-01	47
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	152
Number of employers contributing to the scheme	2023-01-01	0
2018: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	119
Number of retired or separated participants receiving benefits	2018-01-01	17
Number of other retired or separated participants entitled to future benefits	2018-01-01	4
Total of all active and inactive participants	2018-01-01	140
2017: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	118
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	4
Total of all active and inactive participants	2017-01-01	122
2016: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	119
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	3
Total of all active and inactive participants	2016-01-01	122
2015: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	122
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	149
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	13
Total of all active and inactive participants	2015-01-01	162
2014: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	121
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	121
2013: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	133
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	133

Form 5500 Responses for JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN

2023: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2018: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: JACKSON ENERGY COOPERATIVE EMPLOYEE BENEFITS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

305906

Policy instance

Insurance contract or identification number	305906
Number of Individuals Covered	104
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $12,200
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $278,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

10014421001

Policy instance

Insurance contract or identification number	10014421001
Number of Individuals Covered	250
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,597
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E8314148

Policy instance

Insurance contract or identification number	E8314148
Number of Individuals Covered	72
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $7,287
Total amount of fees paid to insurance company	USD $223
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $75,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 )

Policy contract number

L06783

Policy instance

Insurance contract or identification number	L06783
Number of Individuals Covered	278
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $8,634
Total amount of fees paid to insurance company	USD $954
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

134028

Policy instance

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0703690

Policy instance

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

Policy contract number

10014421001

Policy instance

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

Policy contract number

10014431001

Policy instance

ACCESS WELLNESS GROUP,INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

00000

Policy instance

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

KP004

Policy instance

DELTA DENTAL OF KENTUCKY (National Association of Insurance Commissioners NAIC id number: 54674 )

Policy contract number

0703690

Policy instance

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

KP004

Policy instance

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

Policy contract number

10014421001

Policy instance

ACCESS WELLNESS GROUP,INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

00000

Policy instance

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

134028

Policy instance

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

KP004

Policy instance

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

Policy contract number

1001442

Policy instance

ACCESS WELLNESS GROUP,INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

00000

Policy instance

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

00000

Policy instance

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

9031482505

Policy instance

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

134028

Policy instance

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

134028

Policy instance

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

9031482505 000

Policy instance

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000017865

Policy instance

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

00000

Policy instance

ACCESS WELLNESS GROUP,INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

00000

Policy instance

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E8314148

Policy instance

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60049 )

Policy contract number

E8314148

Policy instance

ACCESS WELLNESS GROUP,INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

00000

Policy instance

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

00000

Policy instance

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

9031482505 000

Policy instance

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

0000017865

Policy instance

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

134028

Policy instance

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Company Name:	JACKSON ENERGY COOPERATIVE
Employer identification number (EIN):	610236351
NAIC Classification:	221500