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DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan NameDOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number 501

DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

DOWNTOWN JIMMIE HALE MISSION has sponsored the creation of one or more 401k plans.

Company Name:DOWNTOWN JIMMIE HALE MISSION
Employer identification number (EIN):630358757
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-01-01PERRYN CARROLL2022-10-10
5012020-01-01SHARON FUSSELL2021-06-21
5012019-05-01SHARON FUSSELL2020-07-24
5012018-05-01SHARON FUSSELL2019-08-30
5012017-05-01
5012016-05-01

Plan Statistics for DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN

401k plan membership statisitcs for DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN

Measure Date Value
2021: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0172
Total number of active participants reported on line 7a of the Form 55002021-01-0163
Total of all active and inactive participants2021-01-0163
2020: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01110
Total number of active participants reported on line 7a of the Form 55002020-01-0172
Total of all active and inactive participants2020-01-0172
Total participants2020-01-0172
2019: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-05-01108
Total number of active participants reported on line 7a of the Form 55002019-05-01110
Total of all active and inactive participants2019-05-01110
Total participants2019-05-01110
2018: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-05-01183
Total number of active participants reported on line 7a of the Form 55002018-05-01108
Total of all active and inactive participants2018-05-01108
Total participants2018-05-01108
2017: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-01210
Total number of active participants reported on line 7a of the Form 55002017-05-01183
Total of all active and inactive participants2017-05-01183
Total participants2017-05-01183
2016: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-01210
Total number of active participants reported on line 7a of the Form 55002016-05-01210
Total of all active and inactive participants2016-05-01210
Total participants2016-05-01210

Form 5500 Responses for DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN

2021: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – InsuranceYes
2018: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – InsuranceYes
2017: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – InsuranceYes
2016: DOWNTOWN JIMMIE HALE MISSION EMPLOYEE WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00563377
Policy instance 1
Insurance contract or identification number00563377
Number of Individuals Covered63
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $29,418
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $99,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,719
Additional information about fees paid to insurance brokerCONTRACT 000HG808
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00563377
Policy instance 1
Insurance contract or identification number00563377
Number of Individuals Covered72
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $18,681
Total amount of fees paid to insurance companyUSD $1,558
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $94,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,286
Amount paid for insurance broker fees1558
Additional information about fees paid to insurance brokerCONTRACT ID 0006H868
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05936199
Policy instance 1
Insurance contract or identification numberTM05936199
Number of Individuals Covered110
Insurance policy start date2019-01-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $5,157
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $41,944
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,711
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00563377
Policy instance 2
Insurance contract or identification number00563377
Number of Individuals Covered70
Insurance policy start date2019-07-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $6,312
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $39,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,530
Additional information about fees paid to insurance brokerCONTRACT ID - 0006H868
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05936199
Policy instance 1
Insurance contract or identification numberTM05936199
Number of Individuals Covered108
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $11,279
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $87,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,703
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05936199
Policy instance 1
Insurance contract or identification numberTM05936199
Number of Individuals Covered183
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $12,002
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $94,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,001
Insurance broker organization code?3
Insurance broker nameMY ADVISOR, INC.

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