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PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NamePUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN
Plan identification number 501

PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

JUNTA DE ACCION PUERTORRIQUENA INC. (PUERTO RICAN ACTION BOARD, INC.) has sponsored the creation of one or more 401k plans.

Company Name:JUNTA DE ACCION PUERTORRIQUENA INC. (PUERTO RICAN ACTION BOARD, INC.)
Employer identification number (EIN):221944440
NAIC Classification:812990
NAIC Description:All Other Personal Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-05-01CAROL LARRES2022-11-29
5012020-05-01NADEEM E. SHAHZAD2022-01-24
5012019-05-01ARDAMAN SINGH2021-02-08 ARDAMAN SINGH2021-02-08
5012018-05-01ARDAMAN SINGH2019-11-20
5012017-05-01
5012016-05-01
5012015-05-01CHARLES A WALLACE II
5012014-05-01JOSE MONTES
5012013-05-01

Plan Statistics for PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN

Measure Date Value
2021: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-05-0199
Total number of active participants reported on line 7a of the Form 55002021-05-0187
Number of retired or separated participants receiving benefits2021-05-010
Number of other retired or separated participants entitled to future benefits2021-05-010
Total of all active and inactive participants2021-05-0187
2020: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-05-01155
Total number of active participants reported on line 7a of the Form 55002020-05-01132
Number of retired or separated participants receiving benefits2020-05-015
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-01137
2019: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-05-01115
Total number of active participants reported on line 7a of the Form 55002019-05-01100
Number of retired or separated participants receiving benefits2019-05-012
Number of other retired or separated participants entitled to future benefits2019-05-010
Total of all active and inactive participants2019-05-01102
2018: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-05-01136
Total number of active participants reported on line 7a of the Form 55002018-05-01116
Number of retired or separated participants receiving benefits2018-05-010
Number of other retired or separated participants entitled to future benefits2018-05-010
Total of all active and inactive participants2018-05-01116
Number of employers contributing to the scheme2018-05-010
2017: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-05-01138
Total number of active participants reported on line 7a of the Form 55002017-05-01137
Number of retired or separated participants receiving benefits2017-05-010
Number of other retired or separated participants entitled to future benefits2017-05-010
Total of all active and inactive participants2017-05-01137
2016: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-05-01142
Total number of active participants reported on line 7a of the Form 55002016-05-01111
Number of retired or separated participants receiving benefits2016-05-010
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-01111
2015: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-05-01264
Total number of active participants reported on line 7a of the Form 55002015-05-01142
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-01142
2014: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-05-01251
Total number of active participants reported on line 7a of the Form 55002014-05-01264
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-01264
2013: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-05-010
Total number of active participants reported on line 7a of the Form 55002013-05-01251
Total of all active and inactive participants2013-05-01251
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-05-010

Form 5500 Responses for PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN

2021: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Submission has been amendedNo
2021-05-01This submission is the final filingNo
2021-05-01This return/report is a short plan year return/report (less than 12 months)No
2021-05-01Plan is a collectively bargained planNo
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – InsuranceYes
2020: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Submission has been amendedNo
2020-05-01This submission is the final filingNo
2020-05-01This return/report is a short plan year return/report (less than 12 months)No
2020-05-01Plan is a collectively bargained planNo
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – InsuranceYes
2019: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Submission has been amendedNo
2019-05-01This submission is the final filingNo
2019-05-01This return/report is a short plan year return/report (less than 12 months)No
2019-05-01Plan is a collectively bargained planNo
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – InsuranceYes
2018: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – InsuranceYes
2017: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – InsuranceYes
2016: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – InsuranceYes
2015: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – InsuranceYes
2014: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – InsuranceYes
2013: PUERTO RICAN ACTION BOARD, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01First time form 5500 has been submittedYes
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan 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 number00622918
Policy instance 1
Insurance contract or identification number00622918
Number of Individuals Covered135
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $65,562
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,365,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees65562
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEES INCENTIVE COMPENSATION PAYMENTS
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00622918
Policy instance 1
Insurance contract or identification number00622918
Number of Individuals Covered162
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $66,243
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,392,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees66243
Additional information about fees paid to insurance brokerBENEFIT ADVISOR FEES INCENTIVE COMPENSATION PAYMENTS
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00622918
Policy instance 1
Insurance contract or identification number00622918
Number of Individuals Covered162
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $74,000
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,480,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees74000
Additional information about fees paid to insurance brokerINCENTIVE COMPENSATION PAYMENTS BENEFIT ADVISOR FEES
Insurance broker organization code?3
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberPRI3024
Policy instance 1
Insurance contract or identification numberPRI3024
Number of Individuals Covered259
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $16,868
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $284,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,868
Amount paid for insurance broker fees0
Insurance broker organization code?3
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberPRI3024
Policy instance 1
Insurance contract or identification numberPRI3024
Number of Individuals Covered267
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $69,532
Total amount of fees paid to insurance companyUSD $3,000
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,737,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $69,532
Amount paid for insurance broker fees3000
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameCORPORATE SYNERGIES GROUP, LLC
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberPR13024
Policy instance 1
Insurance contract or identification numberPR13024
Number of Individuals Covered257
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $70,392
Total amount of fees paid to insurance companyUSD $2,000
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,767,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,392
Amount paid for insurance broker fees2000
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameCORPORATE SYNERGIES GROUP, LLC
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberPR13024
Policy instance 1
Insurance contract or identification numberPR13024
Number of Individuals Covered264
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $75,594
Total amount of fees paid to insurance companyUSD $15,177
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,638,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,546
Amount paid for insurance broker fees1800
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameDAVID SIEBEL
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberPR13024
Policy instance 1
Insurance contract or identification numberPR13024
Number of Individuals Covered251
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $66,240
Total amount of fees paid to insurance companyUSD $20,943
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,211,061
Amount paid for insurance broker fees20943
Additional information about fees paid to insurance brokerADMINSTRATIVE SERVICES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $6,624
Insurance broker nameCAPACITY BENEFITS & FINANCIAL

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