401k Plan data: BILL JACOBS JOLIET EMPLOYEE VISION PLAN plan

BILL JACOBS JOLIET EMPLOYEE VISION PLAN 401k Plan overview

Plan Name	BILL JACOBS JOLIET EMPLOYEE VISION PLAN
Plan identification number	503

BILL JACOBS JOLIET EMPLOYEE VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision

401k Sponsoring company profile

BILL JACOBS JOLIET, LLC has sponsored the creation of one or more 401k plans.

Company Name: BILL JACOBS JOLIET, LLC

Employer identification number (EIN): 820578220

NAIC Classification: 441110
NAIC Description: New Car Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BILL JACOBS JOLIET EMPLOYEE VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2015-01-01 ZUHAL GUNGOR

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2015-01-01	ZUHAL GUNGOR

Plan Statistics for BILL JACOBS JOLIET EMPLOYEE VISION PLAN

401k plan membership statisitcs for BILL JACOBS JOLIET EMPLOYEE VISION PLAN

Measure Date Value
2015: BILL JACOBS JOLIET EMPLOYEE VISION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 52
Number of retired or separated participants receiving benefits 2015-01-01 5
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0

Measure	Date	Value
2015: BILL JACOBS JOLIET EMPLOYEE VISION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	52
Number of retired or separated participants receiving benefits	2015-01-01	5
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0

Form 5500 Responses for BILL JACOBS JOLIET EMPLOYEE VISION PLAN

2015: BILL JACOBS JOLIET EMPLOYEE VISION PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

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

Policy contract number

9745589

Policy instance

Insurance contract or identification number	9745589
Number of Individuals Covered	100
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $616
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $5,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $308
Insurance broker organization code?	3
Insurance broker name	MUTUAL BENEFIT PLUS-BOR

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Company Name:	BILL JACOBS JOLIET, LLC
Employer identification number (EIN):	820578220
NAIC Classification:	441110
NAIC Description:	New Car Dealers