401k Plan data: JES PAYROLL CLEARING WELFARE BENEFIT PLAN plan

JES PAYROLL CLEARING WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	JES PAYROLL CLEARING WELFARE BENEFIT PLAN
Plan identification number	501

JES PAYROLL CLEARING WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

JES PAYROLL CLEARING, INC has sponsored the creation of one or more 401k plans.

Company Name: JES PAYROLL CLEARING, INC

Employer identification number (EIN): 731633817

NAIC Classification: 531110
NAIC Description: Lessors of Residential Buildings and Dwellings

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JES PAYROLL CLEARING WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01

Plan Statistics for JES PAYROLL CLEARING WELFARE BENEFIT PLAN

401k plan membership statisitcs for JES PAYROLL CLEARING WELFARE BENEFIT PLAN

Measure Date Value
2017: JES PAYROLL CLEARING WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 306
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 257
Total of all active and inactive participants 2017-01-01 257

Measure	Date	Value
2017: JES PAYROLL CLEARING WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	306
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	257
Total of all active and inactive participants	2017-01-01	257

Form 5500 Responses for JES PAYROLL CLEARING WELFARE BENEFIT PLAN

2017: JES PAYROLL CLEARING WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00414816

Policy instance

Insurance contract or identification number	00414816
Number of Individuals Covered	551
Insurance policy start date	2016-07-01
Insurance policy end date	2017-06-30
Total amount of commissions paid to insurance broker	USD $24,100
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	A D & D
Welfare Benefit Premiums Paid to Carrier	USD $353,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,100
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN BENEFIT COPRPORATION

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

R0541607

Policy instance

Insurance contract or identification number	R0541607
Number of Individuals Covered	269
Insurance policy start date	2016-07-01
Insurance policy end date	2017-06-30
Total amount of commissions paid to insurance broker	USD $6,286
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	HOSPITAL, CRITICAL ILLNESS, ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $58,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,286
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN BENEFITS CORP OF GA

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

905260

Policy instance

Insurance contract or identification number	905260
Number of Individuals Covered	481
Insurance policy start date	2016-07-01
Insurance policy end date	2017-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $127,843
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,389,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	127843
Additional information about fees paid to insurance broker	SERVICE FEE AGREEMENT
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN BENEFIT CORP OF GA

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

98811781001

Policy instance

Insurance contract or identification number	98811781001
Number of Individuals Covered	414
Insurance policy start date	2016-07-01
Insurance policy end date	2017-06-30
Total amount of commissions paid to insurance broker	USD $2,357
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,357
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN BENEFITS CORP OF GA

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Company Name:	JES PAYROLL CLEARING, INC
Employer identification number (EIN):	731633817
NAIC Classification:	531110
NAIC Description:	Lessors of Residential Buildings and Dwellings