401k Plan data: BLUE CARE NETWORK JFS plan

BLUE CARE NETWORK JFS 401k Plan overview

Plan Name	BLUE CARE NETWORK JFS
Plan identification number	503

BLUE CARE NETWORK JFS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

JEWISH FAMILY SERVICE OF METROPOLITAN DETROIT has sponsored the creation of one or more 401k plans.

Company Name: JEWISH FAMILY SERVICE OF METROPOLITAN DETROIT

Employer identification number (EIN): 380691329

NAIC Classification: 624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BLUE CARE NETWORK JFS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2015-01-01 BRETT NICHOLSON BRETT NICHOLSON 2016-05-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2015-01-01	BRETT NICHOLSON		BRETT NICHOLSON	2016-05-09

Plan Statistics for BLUE CARE NETWORK JFS

401k plan membership statisitcs for BLUE CARE NETWORK JFS

Measure Date Value
2015: BLUE CARE NETWORK JFS 2015 401k membership
Total participants, beginning-of-year 2015-01-01 98
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 98
Number of retired or separated participants receiving benefits 2015-01-01 0
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 98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 98

Measure	Date	Value
2015: BLUE CARE NETWORK JFS 2015 401k membership
Total participants, beginning-of-year	2015-01-01	98
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	98
Number of retired or separated participants receiving benefits	2015-01-01	0
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	98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	98

Form 5500 Responses for BLUE CARE NETWORK JFS

2015: BLUE CARE NETWORK JFS 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

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00143535

Policy instance

Insurance contract or identification number	00143535
Number of Individuals Covered	98
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $23,821
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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 $519,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,821
Insurance broker organization code?	1
Insurance broker name	LSG INSURANCE PARTNERS

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Company Name:	JEWISH FAMILY SERVICE OF METROPOLITAN DETROIT
Employer identification number (EIN):	380691329
NAIC Classification:	624100
NAIC Description:	Individual and Family Services