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NSA, LLC DENTAL BENEFIT PLAN 401k Plan overview

Plan NameNSA, LLC DENTAL BENEFIT PLAN
Plan identification number 502

NSA, LLC DENTAL BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Dental

401k Sponsoring company profile

THE JUICE PLUS COMPANY, LLC has sponsored the creation of one or more 401k plans.

Company Name:THE JUICE PLUS COMPANY, LLC
Employer identification number (EIN):204819292
NAIC Classification:339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NSA, LLC DENTAL BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022015-06-01BEVERLY ROBERTSON
5022015-06-01BEVERLY ROBERTSON
5022014-06-01JILL HIDAJI
5022013-06-01JILL HIDAJI
5022012-06-01MICHAEL FERRARIS
5022011-06-01MICHAEL FERRARIS
5022010-06-01MICHAEL FERRARIS
5022009-06-01MICHAEL FERRARIS

Plan Statistics for NSA, LLC DENTAL BENEFIT PLAN

401k plan membership statisitcs for NSA, LLC DENTAL BENEFIT PLAN

Measure Date Value
2015: NSA, LLC DENTAL BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01416
Total number of active participants reported on line 7a of the Form 55002015-06-01435
Total of all active and inactive participants2015-06-01435
Total participants2015-06-010
Number of retired or separated participants receiving benefits2015-06-010
Number of other retired or separated participants entitled to future benefits2015-06-010
2014: NSA, LLC DENTAL BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01394
Total number of active participants reported on line 7a of the Form 55002014-06-01416
Total of all active and inactive participants2014-06-01416
Total participants2014-06-010
2013: NSA, LLC DENTAL BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01386
Total number of active participants reported on line 7a of the Form 55002013-06-01394
Total of all active and inactive participants2013-06-01394
Total participants2013-06-010
2012: NSA, LLC DENTAL BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01354
Total number of active participants reported on line 7a of the Form 55002012-06-01386
Total of all active and inactive participants2012-06-01386
Total participants2012-06-010
2011: NSA, LLC DENTAL BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01333
Total number of active participants reported on line 7a of the Form 55002011-06-01354
Total of all active and inactive participants2011-06-01354
Total participants2011-06-01354
2010: NSA, LLC DENTAL BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01431
Total number of active participants reported on line 7a of the Form 55002010-06-01333
Total of all active and inactive participants2010-06-01333
Total participants2010-06-01333
2009: NSA, LLC DENTAL BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01442
Total number of active participants reported on line 7a of the Form 55002009-06-01431
Total of all active and inactive participants2009-06-01431
Total participants2009-06-01431

Form 5500 Responses for NSA, LLC DENTAL BENEFIT PLAN

2015: NSA, LLC DENTAL BENEFIT PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedYes
2015-06-01This submission is the final filingYes
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planNo
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – InsuranceYes
2014: NSA, LLC DENTAL BENEFIT PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: NSA, LLC DENTAL BENEFIT PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: NSA, LLC DENTAL BENEFIT PLAN 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: NSA, LLC DENTAL BENEFIT PLAN 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – InsuranceYes
2010: NSA, LLC DENTAL BENEFIT PLAN 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan benefit arrangement – InsuranceYes
2009: NSA, LLC DENTAL BENEFIT PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3337885
Policy instance 1
Insurance contract or identification number3337885
Number of Individuals Covered1191
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $20,825
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $416,762
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number118719
Policy instance 1
Insurance contract or identification number118719
Number of Individuals Covered1022
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $7,201
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $47
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,201
Insurance broker organization code?3
Insurance broker nameJAMES C. WRIGHT
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3337885
Policy instance 2
Insurance contract or identification number3337885
Number of Individuals Covered1138
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $16,037
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $400,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,830
Insurance broker organization code?3
Insurance broker nameBENEFIT ADVISORS SERVICES
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number118719
Policy instance 1
Insurance contract or identification number118719
Number of Individuals Covered1065
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $17,970
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,970
Insurance broker organization code?3
Insurance broker nameJAMES C. WRIGHT
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number118719
Policy instance 1
Insurance contract or identification number118719
Number of Individuals Covered1055
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $17,049
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,049
Insurance broker organization code?3
Insurance broker nameJAMES C. WRIGHT
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number118719
Policy instance 1
Insurance contract or identification number118719
Number of Individuals Covered972
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $15,656
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number118719
Policy instance 1
Insurance contract or identification number118719
Number of Individuals Covered955
Insurance policy start date2010-05-01
Insurance policy end date2011-04-30
Total amount of commissions paid to insurance brokerUSD $14,696
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,696
Insurance broker organization code?3
Insurance broker nameJAMES C. WRIGHT

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