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HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 401k Plan overview

Plan NameHEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE
Plan identification number 501

HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision

401k Sponsoring company profile

JEFFERSON ENERGY COOPERATIVE has sponsored the creation of one or more 401k plans.

Company Name:JEFFERSON ENERGY COOPERATIVE
Employer identification number (EIN):580303365
NAIC Classification:221100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01CHRIS DILLARD
5012017-01-01CHRIS DILLARD
5012016-01-01CHRIS DILLARD
5012015-01-01CHRIS DILLARD

Plan Statistics for HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE

401k plan membership statisitcs for HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE

Measure Date Value
2022: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2022 401k membership
Total participants, beginning-of-year2022-01-01134
Total number of active participants reported on line 7a of the Form 55002022-01-01113
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01113
2021: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2021 401k membership
Total participants, beginning-of-year2021-01-01116
Total number of active participants reported on line 7a of the Form 55002021-01-01134
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01134
2020: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2020 401k membership
Total participants, beginning-of-year2020-01-01115
Total number of active participants reported on line 7a of the Form 55002020-01-01116
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01116
2019: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2019 401k membership
Total participants, beginning-of-year2019-01-01115
Total number of active participants reported on line 7a of the Form 55002019-01-01115
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01115
2018: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2018 401k membership
Total participants, beginning-of-year2018-01-01114
Total number of active participants reported on line 7a of the Form 55002018-01-01115
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01115
2017: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2017 401k membership
Total participants, beginning-of-year2017-01-01114
Total number of active participants reported on line 7a of the Form 55002017-01-01114
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01114
2016: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2016 401k membership
Total participants, beginning-of-year2016-01-01106
Total number of active participants reported on line 7a of the Form 55002016-01-01114
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01114
2015: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2015 401k membership
Total participants, beginning-of-year2015-01-01106
Total number of active participants reported on line 7a of the Form 55002015-01-01106
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01106

Form 5500 Responses for HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE

2022: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: HEALTH INSURANCE PLAN FOR EMPLOYEES OF JEFFERSON ENERGY COOPERATIVE 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00511340
Policy instance 3
Insurance contract or identification number00511340
Number of Individuals Covered77
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,548
Total amount of fees paid to insurance companyUSD $524
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,506
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,548
Amount paid for insurance broker fees524
Insurance broker organization code?3
BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 )
Policy contract number47-MSL-000639-0
Policy instance 2
Insurance contract or identification number47-MSL-000639-0
Number of Individuals Covered113
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Welfare Benefit Premiums Paid to CarrierUSD $276,298
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number
Policy instance 1
Number of Individuals Covered113
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $134,969
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00511340
Policy instance 3
Insurance contract or identification number00511340
Number of Individuals Covered71
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,334
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,334
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number939604
Policy instance 2
Insurance contract or identification number939604
Number of Individuals Covered118
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Welfare Benefit Premiums Paid to CarrierUSD $258,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number
Policy instance 1
Number of Individuals Covered115
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $133,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number
Policy instance 3
Number of Individuals Covered112
Insurance policy start date2020-04-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $46,305
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,305
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number939604
Policy instance 2
Insurance contract or identification number939604
Number of Individuals Covered113
Insurance policy start date2020-04-01
Insurance policy end date2021-03-31
Welfare Benefit Premiums Paid to CarrierUSD $231,822
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberG0386
Policy instance 1
Insurance contract or identification numberG0386
Number of Individuals Covered116
Insurance policy start date2020-01-01
Insurance policy end date2020-03-31
Total amount of commissions paid to insurance brokerUSD $14,688
Total amount of fees paid to insurance companyUSD $5,049
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $229,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,688
Insurance broker organization code?3
Amount paid for insurance broker fees5049
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION COMMUNICATION AND TRAINING
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberG0386
Policy instance 1
Insurance contract or identification numberG0386
Number of Individuals Covered115
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $43,808
Total amount of fees paid to insurance companyUSD $14,795
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,808
Insurance broker organization code?3
Amount paid for insurance broker fees14795
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION, TRAINING
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberG0386
Policy instance 1
Insurance contract or identification numberG0386
Number of Individuals Covered115
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $51,194
Total amount of fees paid to insurance companyUSD $5,566
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,240
Insurance broker organization code?3
Amount paid for insurance broker fees5566
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION, TRAINING
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberG0386
Policy instance 1
Insurance contract or identification numberG0386
Number of Individuals Covered114
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $57,147
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,520
Insurance broker organization code?3
Insurance broker nameGLENN DAVIS & ASSOCIATES, INC.
BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract numberG0386
Policy instance 1
Insurance contract or identification numberG0386
Number of Individuals Covered106
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $43,546
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,258
Insurance broker nameGLENN DAVIS & ASSOCIATES, INC.

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