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JAKES INC. PPO EMPLOYEE HEALTH PLAN 401k Plan overview

Plan NameJAKES INC. PPO EMPLOYEE HEALTH PLAN
Plan identification number 501

JAKES INC. PPO EMPLOYEE HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Other welfare benefit cover

401k Sponsoring company profile

JAKES, INC. has sponsored the creation of one or more 401k plans.

Company Name:JAKES, INC.
Employer identification number (EIN):741936814
NAIC Classification:424400

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JAKES INC. PPO EMPLOYEE HEALTH PLAN

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
5012018-01-01
5012017-01-01ELIZABETH BARNETT
5012016-01-01ELIZABETH BARNETT
5012015-01-01ELIZABETH BARNETT
5012014-01-01ELIZABETH BARNETT
5012013-01-01ELIZABETH BARNETT
5012012-01-01PATSY SAKOWITZ
5012011-01-01PATSY SAKOWITZ
5012010-01-01PATSY SAKOWITZ2011-10-13
5012009-01-01PATSY J. SAKOWITZ

Plan Statistics for JAKES INC. PPO EMPLOYEE HEALTH PLAN

401k plan membership statisitcs for JAKES INC. PPO EMPLOYEE HEALTH PLAN

Measure Date Value
2022: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01223
Total number of active participants reported on line 7a of the Form 55002022-01-010
Total of all active and inactive participants2022-01-010
2021: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01237
Total number of active participants reported on line 7a of the Form 55002021-01-01223
Total of all active and inactive participants2021-01-01223
2020: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01232
Total number of active participants reported on line 7a of the Form 55002020-01-01237
Total of all active and inactive participants2020-01-01237
2019: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01248
Total number of active participants reported on line 7a of the Form 55002019-01-01232
Total of all active and inactive participants2019-01-01232
2018: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01375
Total number of active participants reported on line 7a of the Form 55002018-01-01248
Total of all active and inactive participants2018-01-01248
2017: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01131
Total number of active participants reported on line 7a of the Form 55002017-01-01375
Total of all active and inactive participants2017-01-01375
2016: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01128
Total number of active participants reported on line 7a of the Form 55002016-01-01131
Total of all active and inactive participants2016-01-01131
2015: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01109
Total number of active participants reported on line 7a of the Form 55002015-01-01116
Total of all active and inactive participants2015-01-01116
2014: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0189
Total number of active participants reported on line 7a of the Form 55002014-01-01109
Total of all active and inactive participants2014-01-01109
2013: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01105
Total number of active participants reported on line 7a of the Form 55002013-01-0189
Total of all active and inactive participants2013-01-0189
2012: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01136
Total number of active participants reported on line 7a of the Form 55002012-01-01136
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01136
2011: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01139
Total number of active participants reported on line 7a of the Form 55002011-01-01136
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01136
2009: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0161
Total number of active participants reported on line 7a of the Form 55002009-01-0175
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0175

Financial Data on JAKES INC. PPO EMPLOYEE HEALTH PLAN

Measure Date Value
2022 : JAKES INC. PPO EMPLOYEE HEALTH PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$55,202
Total income from all sources (including contributions)2022-12-31$103,759
Total of all expenses incurred2022-12-31$103,759
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$91,242
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$103,759
Value of total assets at beginning of year2022-12-31$55,202
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$12,517
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31No
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$55,202
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$43,387
Administrative expenses (other) incurred2022-12-31$12,517
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$0
Value of net assets at end of year (total assets less liabilities)2022-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$103,759
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$91,242
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
Liabilities. Value of benefit claims payable at end of year2022-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$11,815
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31Yes
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31BROUSSARD & COMPANY CPA'S, LLC
Accountancy firm EIN2022-12-31721447940
2021 : JAKES INC. PPO EMPLOYEE HEALTH PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$55,202
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$66,277
Total income from all sources (including contributions)2021-12-31$1,740,985
Total of all expenses incurred2021-12-31$1,740,985
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,665,274
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,740,985
Value of total assets at end of year2021-12-31$55,202
Value of total assets at beginning of year2021-12-31$66,277
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$75,711
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31No
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$591,760
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$55,202
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$47,933
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$43,387
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$42,798
Administrative expenses (other) incurred2021-12-31$75,711
Total non interest bearing cash at beginning of year2021-12-31$18,344
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$0
Value of net assets at end of year (total assets less liabilities)2021-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$493,557
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$1,149,225
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,171,717
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Liabilities. Value of benefit claims payable at end of year2021-12-31$11,815
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$23,479
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31BROUSSARD & COMPANY CPA'S, LLC
Accountancy firm EIN2021-12-31721447940
2020 : JAKES INC. PPO EMPLOYEE HEALTH PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$66,277
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$46,713
Total income from all sources (including contributions)2020-12-31$1,511,765
Total of all expenses incurred2020-12-31$1,563,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$1,515,590
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,511,765
Value of total assets at end of year2020-12-31$66,277
Value of total assets at beginning of year2020-12-31$98,655
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$48,117
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31No
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$550,937
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$47,933
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$98,655
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$42,798
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$4,476
Administrative expenses (other) incurred2020-12-31$48,117
Total non interest bearing cash at end of year2020-12-31$18,344
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-51,942
Value of net assets at end of year (total assets less liabilities)2020-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$51,942
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$475,365
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$960,828
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$1,040,225
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Liabilities. Value of benefit claims payable at end of year2020-12-31$23,479
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$42,237
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31BROUSSARD & COMPANY CPA'S, LLC
Accountancy firm EIN2020-12-31721447940
2019 : JAKES INC. PPO EMPLOYEE HEALTH PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$46,713
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$48,211
Total income from all sources (including contributions)2019-12-31$1,559,575
Total of all expenses incurred2019-12-31$1,794,003
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$1,740,934
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,117,122
Value of total assets at end of year2019-12-31$98,655
Value of total assets at beginning of year2019-12-31$334,581
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$53,069
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$517,274
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$98,655
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$19,194
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$4,476
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$5,760
Other income not declared elsewhere2019-12-31$442,453
Administrative expenses (other) incurred2019-12-31$53,069
Total non interest bearing cash at beginning of year2019-12-31$315,387
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-234,428
Value of net assets at end of year (total assets less liabilities)2019-12-31$51,942
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$286,370
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$366,284
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$599,848
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$1,374,650
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Liabilities. Value of benefit claims payable at end of year2019-12-31$42,237
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$42,451
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31BROUSSARD & COMPANY CPA'S, LLC
Accountancy firm EIN2019-12-31721447940
2018 : JAKES INC. PPO EMPLOYEE HEALTH PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$48,211
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$14,335
Total income from all sources (including contributions)2018-12-31$1,943,461
Total of all expenses incurred2018-12-31$1,657,091
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,590,361
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,912,604
Value of total assets at end of year2018-12-31$334,581
Value of total assets at beginning of year2018-12-31$14,335
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$66,730
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31No
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$511,911
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$19,194
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$5,760
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$5,598
Other income not declared elsewhere2018-12-31$30,857
Administrative expenses (other) incurred2018-12-31$66,730
Total non interest bearing cash at end of year2018-12-31$315,387
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$286,370
Value of net assets at end of year (total assets less liabilities)2018-12-31$286,370
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$330,571
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$1,400,693
Employer contributions (assets) at beginning of year2018-12-31$14,335
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$1,259,790
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Liabilities. Value of benefit claims payable at end of year2018-12-31$42,451
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$8,737
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31BROUSSARD & COMPANY CPA'S, LLC
Accountancy firm EIN2018-12-31721447940
2017 : JAKES INC. PPO EMPLOYEE HEALTH PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$14,335
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$31,160
Total income from all sources (including contributions)2017-12-31$942,407
Total of all expenses incurred2017-12-31$942,407
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$876,047
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$942,407
Value of total assets at end of year2017-12-31$14,335
Value of total assets at beginning of year2017-12-31$31,160
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$66,360
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31No
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$503,715
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$4,859
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$5,598
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$5,930
Administrative expenses (other) incurred2017-12-31$66,360
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$0
Value of net assets at end of year (total assets less liabilities)2017-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$292,623
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$438,692
Employer contributions (assets) at end of year2017-12-31$14,335
Employer contributions (assets) at beginning of year2017-12-31$26,301
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$583,424
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Liabilities. Value of benefit claims payable at end of year2017-12-31$8,737
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$25,230
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31BROUSSARD & COMPANY CPA'S, LLC
Accountancy firm EIN2017-12-31721447940
2016 : JAKES INC. PPO EMPLOYEE HEALTH PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$31,160
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$80,697
Total income from all sources (including contributions)2016-12-31$1,189,815
Total of all expenses incurred2016-12-31$1,189,815
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$1,127,184
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,012,580
Value of total assets at end of year2016-12-31$31,160
Value of total assets at beginning of year2016-12-31$80,697
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$62,631
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31No
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$470,770
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$4,859
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$58,432
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$5,930
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$5,597
Other income not declared elsewhere2016-12-31$177,235
Administrative expenses (other) incurred2016-12-31$62,631
Total non interest bearing cash at end of year2016-12-31$0
Total non interest bearing cash at beginning of year2016-12-31$1,427
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$0
Value of net assets at end of year (total assets less liabilities)2016-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$306,607
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$541,810
Employer contributions (assets) at end of year2016-12-31$26,301
Employer contributions (assets) at beginning of year2016-12-31$20,838
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$820,577
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Liabilities. Value of benefit claims payable at end of year2016-12-31$25,230
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$75,100
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31BROUSSARD & COMPANY CPA'S, LLC
Accountancy firm EIN2016-12-31721447940
2013 : JAKES INC. PPO EMPLOYEE HEALTH PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$10,416
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$694,806
Total of all expenses incurred2013-12-31$694,806
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$674,506
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$694,806
Value of total assets at end of year2013-12-31$10,416
Value of total assets at beginning of year2013-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$20,300
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31No
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$219,911
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$0
Value of net assets at end of year (total assets less liabilities)2013-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$273,932
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$474,895
Employer contributions (assets) at end of year2013-12-31$10,416
Employer contributions (assets) at beginning of year2013-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$400,574
Contract administrator fees2013-12-31$20,300
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Liabilities. Value of benefit claims payable at end of year2013-12-31$10,416
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$0
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31BROUSSARD & COMPANY CPA'S, LLC
Accountancy firm EIN2013-12-31721447940

Form 5500 Responses for JAKES INC. PPO EMPLOYEE HEALTH PLAN

2022: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01This submission is the final filingYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01First time form 5500 has been submittedYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2011 form 5500 responses
2011-01-01Type of plan entityMulti-employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: JAKES INC. PPO EMPLOYEE HEALTH PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number155480
Policy instance 1
Insurance contract or identification number155480
Number of Individuals Covered223
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,086
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $494,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees3086
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number155480
Policy instance 1
Insurance contract or identification number155480
Number of Individuals Covered237
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $475,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number155480
Policy instance 1
Insurance contract or identification number155480
Number of Individuals Covered232
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,120
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1120
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number155480
Policy instance 1
Insurance contract or identification number155480
Number of Individuals Covered248
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,179
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1179
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number155480
Policy instance 1
Insurance contract or identification number155480
Number of Individuals Covered236
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number155480
Policy instance 1
Insurance contract or identification number155480
Number of Individuals Covered116
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,000
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees3000
Additional information about fees paid to insurance brokerSPECIAL PROGRAM FEES
Insurance broker organization code?3
Insurance broker nameFROST INSURANCE AGENCY
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-012361-000
Policy instance 1
Insurance contract or identification number16-012361-000
Number of Individuals Covered109
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $47,897
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $319,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,897
Insurance broker organization code?5
Insurance broker nameEPSI BENEFITS, INC.
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-012361-000
Policy instance 1
Insurance contract or identification number16-012361-000
Number of Individuals Covered89
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $32,427
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $258,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,427
Insurance broker organization code?5
Insurance broker nameEPSI BENEFITS, INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNOT AVAILABLE
Policy instance 2
Insurance contract or identification numberNOT AVAILABLE
Number of Individuals Covered89
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $15,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7018757
Policy instance 1
Insurance contract or identification numberE7018757
Number of Individuals Covered14
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $50
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER AND ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameBRUCE BOYLES
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0715945
Policy instance 2
Insurance contract or identification number0715945
Number of Individuals Covered122
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $33,316
Total amount of fees paid to insurance companyUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,316
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameEPSI BENEFITS INC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0715945
Policy instance 2
Insurance contract or identification number0715945
Number of Individuals Covered122
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $28,472
Total amount of fees paid to insurance companyUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7018757
Policy instance 1
Insurance contract or identification numberE7018757
Number of Individuals Covered14
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $682
Total amount of fees paid to insurance companyUSD $48
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 BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedCANCER AND ACCIDENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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