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4JLJ HEALTH & WELFARE BENEFIT PLAN 401k Plan overview

Plan Name4JLJ HEALTH & WELFARE BENEFIT PLAN
Plan identification number 501

4JLJ HEALTH & WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

4JLJ, LLC has sponsored the creation of one or more 401k plans.

Company Name:4JLJ, LLC
Employer identification number (EIN):742248672
NAIC Classification:211120
NAIC Description:Crude Petroleum Extraction

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 4JLJ HEALTH & WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-01-01BECKY CLARK2024-02-23
5012022-01-01BECKY CLARK2023-03-27
5012021-01-01BECKY CLARK2022-03-07
5012020-01-01REBEKKAH CLARK2021-03-19
5012019-01-01TERRI JALUFKA2020-07-16
5012018-01-01BECKY CLARK2019-08-22

Plan Statistics for 4JLJ HEALTH & WELFARE BENEFIT PLAN

401k plan membership statisitcs for 4JLJ HEALTH & WELFARE BENEFIT PLAN

Measure Date Value
2023: 4JLJ HEALTH & WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01179
Total number of active participants reported on line 7a of the Form 55002023-01-01179
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01179
Number of employers contributing to the scheme2023-01-010
2022: 4JLJ HEALTH & WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01142
Total number of active participants reported on line 7a of the Form 55002022-01-01179
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01179
Number of employers contributing to the scheme2022-01-010
2021: 4JLJ HEALTH & WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01114
Total number of active participants reported on line 7a of the Form 55002021-01-01142
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01142
Number of employers contributing to the scheme2021-01-010
2020: 4JLJ HEALTH & WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01196
Total number of active participants reported on line 7a of the Form 55002020-01-01114
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01114
Number of employers contributing to the scheme2020-01-010
2019: 4JLJ HEALTH & WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0161
Total number of active participants reported on line 7a of the Form 55002019-01-01196
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01196
Number of employers contributing to the scheme2019-01-010
2018: 4JLJ HEALTH & WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0185
Total number of active participants reported on line 7a of the Form 55002018-01-0161
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0161
Number of employers contributing to the scheme2018-01-010

Form 5500 Responses for 4JLJ HEALTH & WELFARE BENEFIT PLAN

2023: 4JLJ HEALTH & WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: 4JLJ HEALTH & WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: 4JLJ HEALTH & 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: 4JLJ HEALTH & 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: 4JLJ HEALTH & WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: 4JLJ HEALTH & WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01First time form 5500 has been submittedYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )
Policy contract number784330
Policy instance 2
Insurance contract or identification number784330
Number of Individuals Covered153
Insurance policy start date2023-01-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $18,871
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $298,516
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number784330
Policy instance 1
Insurance contract or identification number784330
Number of Individuals Covered179
Insurance policy start date2023-01-01
Insurance policy end date2023-05-31
Total amount of commissions paid to insurance brokerUSD $5,599
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $40,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )
Policy contract number784330
Policy instance 2
Insurance contract or identification number784330
Number of Individuals Covered148
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $43,782
Total amount of fees paid to insurance companyUSD $6,016
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $884,873
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,701
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS, NON-MONETARY COMMISSION
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number784330
Policy instance 1
Insurance contract or identification number784330
Number of Individuals Covered179
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $12,425
Total amount of fees paid to insurance companyUSD $1,361
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $114,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,797
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS, NON-MONETARY COMMISSION
HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )
Policy contract number784330
Policy instance 2
Insurance contract or identification number784330
Number of Individuals Covered128
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $36,179
Total amount of fees paid to insurance companyUSD $6,773
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $740,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,179
Amount paid for insurance broker fees6773
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number784330
Policy instance 1
Insurance contract or identification number784330
Number of Individuals Covered142
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,704
Total amount of fees paid to insurance companyUSD $1,135
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $89,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,704
Amount paid for insurance broker fees1135
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HUMANA HEALTH PLAN OF TEXAS, INC. (National Association of Insurance Commissioners NAIC id number: 95024 )
Policy contract number784330
Policy instance 2
Insurance contract or identification number784330
Number of Individuals Covered98
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $40,486
Total amount of fees paid to insurance companyUSD $9,072
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $872,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,486
Amount paid for insurance broker fees9072
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number784330
Policy instance 1
Insurance contract or identification number1455734
Number of Individuals Covered4
Insurance policy start date2011-05-31
Insurance policy end date2012-05-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $100,266
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,370
Amount paid for insurance broker fees1781
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number784330
Policy instance 1
Insurance contract or identification number784330
Number of Individuals Covered196
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $61,965
Total amount of fees paid to insurance companyUSD $13,846
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,041,628
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,965
Amount paid for insurance broker fees13846
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number784330
Policy instance 1
Insurance contract or identification number784330
Number of Individuals Covered142
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $49,889
Total amount of fees paid to insurance companyUSD $4,602
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $824,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,249
Amount paid for insurance broker fees4602
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3

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