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NSA, LLC LIFE INSURANCE PLAN 401k Plan overview

Plan NameNSA, LLC LIFE INSURANCE PLAN
Plan identification number 504

NSA, LLC LIFE INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Death benefits (include travel accident but not life insurance)

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 LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042015-01-01BEVERLY ROBERTSON
5042015-01-01BEVERLY ROBERTSON
5042014-01-01JILL HIDAJI
5042013-01-01JILL HIDAJI
5042012-01-01MICHAEL FERRARIS
5042011-01-01MICHAEL FERRARIS
5042010-01-01MICHAEL FERRARIS
5042009-01-01MICHAEL FERRARIS

Plan Statistics for NSA, LLC LIFE INSURANCE PLAN

401k plan membership statisitcs for NSA, LLC LIFE INSURANCE PLAN

Measure Date Value
2015: NSA, LLC LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01477
Total number of active participants reported on line 7a of the Form 55002015-01-01511
Total of all active and inactive participants2015-01-01511
Total participants2015-01-010
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
2014: NSA, LLC LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01452
Total number of active participants reported on line 7a of the Form 55002014-01-01477
Total of all active and inactive participants2014-01-01477
Total participants2014-01-010
2013: NSA, LLC LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01406
Total number of active participants reported on line 7a of the Form 55002013-01-01452
Total of all active and inactive participants2013-01-01452
Total participants2013-01-010
2012: NSA, LLC LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01406
Total number of active participants reported on line 7a of the Form 55002012-01-01406
Total of all active and inactive participants2012-01-01406
Total participants2012-01-010
2011: NSA, LLC LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01412
Total number of active participants reported on line 7a of the Form 55002011-01-01406
Total of all active and inactive participants2011-01-01406
Total participants2011-01-01406
2010: NSA, LLC LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01479
Total number of active participants reported on line 7a of the Form 55002010-01-01412
Total of all active and inactive participants2010-01-01412
Total participants2010-01-01412
2009: NSA, LLC LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01476
Total number of active participants reported on line 7a of the Form 55002009-01-01479
Total of all active and inactive participants2009-01-01479
Total participants2009-01-01479

Form 5500 Responses for NSA, LLC LIFE INSURANCE PLAN

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

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX965876
Policy instance 1
Insurance contract or identification numberFLX965876
Number of Individuals Covered511
Insurance policy start date2015-04-01
Insurance policy end date2016-04-01
Total amount of commissions paid to insurance brokerUSD $15,578
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $131,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX965876
Policy instance 1
Insurance contract or identification numberFLX965876
Number of Individuals Covered475
Insurance policy start date2014-04-01
Insurance policy end date2015-04-01
Total amount of commissions paid to insurance brokerUSD $17,546
Total amount of fees paid to insurance companyUSD $2,934
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $127,473
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,621
Amount paid for insurance broker fees2934
Additional information about fees paid to insurance brokerOVERRIDE
Insurance broker organization code?3
Insurance broker nameBENEFIT ADVISORS SERVICES
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000713K
Policy instance 1
Insurance contract or identification numberG000713K
Number of Individuals Covered450
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $13,077
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,766
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,077
Insurance broker organization code?3
Insurance broker nameLIPSCOMB & PITTS INS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000713K
Policy instance 1
Insurance contract or identification numberG000713K
Number of Individuals Covered429
Insurance policy start date2012-01-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $12,275
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $122,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,275
Insurance broker organization code?3
Insurance broker nameLIPSCOMB & PITTS INS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000713K
Policy instance 1
Insurance contract or identification numberG000713K
Number of Individuals Covered406
Insurance policy start date2011-01-01
Insurance policy end date2012-01-01
Total amount of commissions paid to insurance brokerUSD $11,759
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $117,587
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 numberG000713K
Policy instance 1
Insurance contract or identification numberG000713K
Number of Individuals Covered412
Insurance policy start date2010-01-01
Insurance policy end date2011-01-01
Total amount of commissions paid to insurance brokerUSD $10,585
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,585
Insurance broker organization code?3
Insurance broker nameLIPSCOMB & PITTS INS LLC

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