401k Plan data: LATTER & BLUM MEDICAL PLAN plan

LATTER & BLUM MEDICAL PLAN 401k Plan overview

Plan Name	LATTER & BLUM MEDICAL PLAN
Plan identification number	502

LATTER & BLUM MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

LATTER & BLUM / CJ BROWN, LLC has sponsored the creation of one or more 401k plans.

Company Name: LATTER & BLUM / CJ BROWN, LLC

Employer identification number (EIN): 721081068

NAIC Classification: 531210
NAIC Description: Offices of Real Estate Agents and Brokers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LATTER & BLUM MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01 COURTNEY DARDEN 2023-07-11
502 2022-01-01 COURTNEY DARDEN 2024-07-23
502 2021-01-01 COURTNEY DARDEN 2022-07-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2022-01-01	COURTNEY DARDEN	2023-07-11
502	2022-01-01	COURTNEY DARDEN	2024-07-23
502	2021-01-01	COURTNEY DARDEN	2022-07-22

Plan Statistics for LATTER & BLUM MEDICAL PLAN

401k plan membership statisitcs for LATTER & BLUM MEDICAL PLAN

Measure Date Value
2022: LATTER & BLUM MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 94
Number of retired or separated participants receiving benefits 2022-01-01 2
Number of other retired or separated participants entitled to future benefits 2022-01-01 4
Total of all active and inactive participants 2022-01-01 100
2021: LATTER & BLUM MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 134
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 4
Total of all active and inactive participants 2021-01-01 138

Measure	Date	Value
2022: LATTER & BLUM MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	94
Number of retired or separated participants receiving benefits	2022-01-01	2
Number of other retired or separated participants entitled to future benefits	2022-01-01	4
Total of all active and inactive participants	2022-01-01	100
2021: LATTER & BLUM MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	134
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	4
Total of all active and inactive participants	2021-01-01	138

Form 5500 Responses for LATTER & BLUM MEDICAL PLAN

2022: LATTER & BLUM MEDICAL PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: LATTER & BLUM MEDICAL PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

580705

Policy instance

Insurance contract or identification number	580705
Number of Individuals Covered	94
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $26,563
Total amount of fees paid to insurance company	USD $7,431
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $720,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,563
Amount paid for insurance broker fees	7431
Additional information about fees paid to insurance broker	COMMISSIONS AND FEES
Insurance broker organization code?	3

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

Policy contract number

580705

Policy instance

Insurance contract or identification number	580705
Number of Individuals Covered	134
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $31,115
Total amount of fees paid to insurance company	USD $3,865
Are there contracts with allocated funds for individual policies?	0
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $842,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,115
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

Potentially related plans

LATTER & BLUM HOLDING, LLC 401(K) PLAN [EIN = 204040237]

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Company Name:	LATTER & BLUM / CJ BROWN, LLC
Employer identification number (EIN):	721081068
NAIC Classification:	531210
NAIC Description:	Offices of Real Estate Agents and Brokers