401k Plan data: JOSEPH MACHINE COMPANY, INC. EMPLOYEE BENEFIT PLAN plan

JOSEPH MACHINE COMPANY, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	JOSEPH MACHINE COMPANY, INC. EMPLOYEE BENEFIT PLAN
Plan identification number	502

JOSEPH MACHINE COMPANY, INC. EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

JOSEPH MACHINE COMPANY, INC has sponsored the creation of one or more 401k plans.

Company Name: JOSEPH MACHINE COMPANY, INC

Employer identification number (EIN): 251605514

NAIC Classification: 333200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOSEPH MACHINE COMPANY, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-01-01 KAREN HEETER 2024-08-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2023-01-01	KAREN HEETER	2024-08-23

Form 5500 Responses for JOSEPH MACHINE COMPANY, INC. EMPLOYEE BENEFIT PLAN

2023: JOSEPH MACHINE COMPANY, INC. EMPLOYEE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLTD0C48Y

Policy instance

Insurance contract or identification number	GLTD0C48Y
Number of Individuals Covered	117
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $3,092
Total amount of fees paid to insurance company	USD $3,603
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

A20128-000

Policy instance

Insurance contract or identification number	A20128-000
Number of Individuals Covered	210
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $8,015
Total amount of fees paid to insurance company	USD $1,603
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $80,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

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

Policy contract number

50933

Policy instance

Insurance contract or identification number	50933
Number of Individuals Covered	210
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $602
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0C48Y

Policy instance

Insurance contract or identification number	GLUG0C48Y
Number of Individuals Covered	117
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,748
Total amount of fees paid to insurance company	USD $2,096
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $17,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUG0C48Y

Policy instance

Insurance contract or identification number	GUG0C48Y
Number of Individuals Covered	117
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,958
Total amount of fees paid to insurance company	USD $2,355
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $19,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	JOSEPH MACHINE COMPANY, INC
Employer identification number (EIN):	251605514
NAIC Classification:	333200