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JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN 401k Plan overview

Plan NameJAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN
Plan identification number 502

JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

JAMESTOWN SKLALLAM TRIBE has sponsored the creation of one or more 401k plans.

Company Name:JAMESTOWN SKLALLAM TRIBE
Employer identification number (EIN):910963298
NAIC Classification:921000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022013-07-01DIANE GANGE
5022013-07-01
5022012-07-01W RON ALLEN
5022011-07-01W. RON ALLEN
5022010-07-01DIANE M GANGE

Plan Statistics for JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN

401k plan membership statisitcs for JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN

Measure Date Value
2013: JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01220
Total number of active participants reported on line 7a of the Form 55002013-07-01217
Total of all active and inactive participants2013-07-01217
Total participants2013-07-01217
Number of retired or separated participants receiving benefits2013-07-010
Number of other retired or separated participants entitled to future benefits2013-07-010
Number of employers contributing to the scheme2013-07-010
2012: JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01173
Total number of active participants reported on line 7a of the Form 55002012-07-01220
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01220
2011: JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01179
Total number of active participants reported on line 7a of the Form 55002011-07-01179
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01179
2010: JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN 2010 401k membership
Total participants, beginning-of-year2010-07-01179
Total number of active participants reported on line 7a of the Form 55002010-07-01173
Number of retired or separated participants receiving benefits2010-07-010
Number of other retired or separated participants entitled to future benefits2010-07-010
Total of all active and inactive participants2010-07-01173

Form 5500 Responses for JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN

2013: JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: JAMESTOWN SKLALLAM TRIBE LIFE AND DISABILITY PLAN 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01First time form 5500 has been submittedYes
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AJZR
Policy instance 1
Insurance contract or identification numberGLUG0AJZR
Number of Individuals Covered217
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Total amount of commissions paid to insurance brokerUSD $11,428
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $114,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,428
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameBROWN AND BROWN OF WASHINGTON, INC.

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