401k Plan data: JP CULLEN AND SONS, INC. HEALTH AND WELFARE PLAN plan

JP CULLEN AND SONS, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	JP CULLEN AND SONS, INC. HEALTH AND WELFARE PLAN
Plan identification number	505

JP CULLEN AND SONS, INC. HEALTH AND WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

J. P. CULLEN & SONS, INC. has sponsored the creation of one or more 401k plans.

Company Name: J. P. CULLEN & SONS, INC.

Employer identification number (EIN): 391367756

NAIC Classification: 236200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JP CULLEN AND SONS, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2022-03-01

Plan Statistics for JP CULLEN AND SONS, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for JP CULLEN AND SONS, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2022: JP CULLEN AND SONS, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-03-01 162
Total number of active participants reported on line 7a of the Form 5500 2022-03-01 183
Number of retired or separated participants receiving benefits 2022-03-01 1
Total of all active and inactive participants 2022-03-01 184

Measure	Date	Value
2022: JP CULLEN AND SONS, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-03-01	162
Total number of active participants reported on line 7a of the Form 5500	2022-03-01	183
Number of retired or separated participants receiving benefits	2022-03-01	1
Total of all active and inactive participants	2022-03-01	184

Form 5500 Responses for JP CULLEN AND SONS, INC. HEALTH AND WELFARE PLAN

2022: JP CULLEN AND SONS, INC. HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-03-01	Type of plan entity	Single employer plan
2022-03-01	First time form 5500 has been submitted	Yes
2022-03-01	Submission has been amended	No
2022-03-01	This submission is the final filing	No
2022-03-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-03-01	Plan is a collectively bargained plan	No
2022-03-01	Plan funding arrangement – Insurance	Yes
2022-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54046 )

Policy contract number

10810 00000

Policy instance

Insurance contract or identification number	10810 00000
Number of Individuals Covered	149
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $9,080
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,080
Insurance broker organization code?	3

NETWORK HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95737 )

Policy contract number

2002214

Policy instance

Insurance contract or identification number	2002214
Number of Individuals Covered	39
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-23
Total amount of commissions paid to insurance broker	USD $10,760
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $822,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,760
Insurance broker organization code?	3

DEAN HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 96156 )

Policy contract number

1978

Policy instance

Insurance contract or identification number	1978
Number of Individuals Covered	263
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-23
Total amount of commissions paid to insurance broker	USD $21,952
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,631,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,952
Insurance broker organization code?	3

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

911586

Policy instance

Insurance contract or identification number	911586
Number of Individuals Covered	184
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $2,896
Total amount of fees paid to insurance company	USD $116
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $36,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,896
Insurance broker organization code?	3
Amount paid for insurance broker fees	116
Additional information about fees paid to insurance broker	BONUS

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

919414

Policy instance

Insurance contract or identification number	919414
Number of Individuals Covered	181
Insurance policy start date	2022-03-01
Insurance policy end date	2023-02-28
Total amount of commissions paid to insurance broker	USD $4,371
Total amount of fees paid to insurance company	USD $288
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $90,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,371
Insurance broker organization code?	3
Amount paid for insurance broker fees	288
Additional information about fees paid to insurance broker	BONUS

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Company Name:	J. P. CULLEN & SONS, INC.
Employer identification number (EIN):	391367756
NAIC Classification:	236200