401k Plan data: DATA INTENSITY, LLC MEDICAL PLAN plan

DATA INTENSITY, LLC MEDICAL PLAN 401k Plan overview

Plan Name	DATA INTENSITY, LLC MEDICAL PLAN
Plan identification number	504

DATA INTENSITY, LLC MEDICAL PLAN Benefits

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

401k Sponsoring company profile

DATA INTENSITY, LLC has sponsored the creation of one or more 401k plans.

Company Name: DATA INTENSITY, LLC

Employer identification number (EIN): 043567891

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Additional information about DATA INTENSITY, LLC

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: 201511310275

More information about DATA INTENSITY, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DATA INTENSITY, LLC MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2015-09-01 STACEY KARACEK
504 2015-09-01
504 2014-09-01 KEVIN SHONE

Plan Statistics for DATA INTENSITY, LLC MEDICAL PLAN

401k plan membership statisitcs for DATA INTENSITY, LLC MEDICAL PLAN

Measure Date Value
2015: DATA INTENSITY, LLC MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-09-01 204
Total number of active participants reported on line 7a of the Form 5500 2015-09-01 203
Number of retired or separated participants receiving benefits 2015-09-01 0
Number of other retired or separated participants entitled to future benefits 2015-09-01 0
Total of all active and inactive participants 2015-09-01 203
2014: DATA INTENSITY, LLC MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-09-01 100
Total number of active participants reported on line 7a of the Form 5500 2014-09-01 204
Number of retired or separated participants receiving benefits 2014-09-01 0
Number of other retired or separated participants entitled to future benefits 2014-09-01 0
Total of all active and inactive participants 2014-09-01 204

Measure	Date	Value
2015: DATA INTENSITY, LLC MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-09-01	204
Total number of active participants reported on line 7a of the Form 5500	2015-09-01	203
Number of retired or separated participants receiving benefits	2015-09-01	0
Number of other retired or separated participants entitled to future benefits	2015-09-01	0
Total of all active and inactive participants	2015-09-01	203
2014: DATA INTENSITY, LLC MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-09-01	100
Total number of active participants reported on line 7a of the Form 5500	2014-09-01	204
Number of retired or separated participants receiving benefits	2014-09-01	0
Number of other retired or separated participants entitled to future benefits	2014-09-01	0
Total of all active and inactive participants	2014-09-01	204

Form 5500 Responses for DATA INTENSITY, LLC MEDICAL PLAN

2015: DATA INTENSITY, LLC MEDICAL PLAN 2015 form 5500 responses
2015-09-01	Type of plan entity	Single employer plan
2015-09-01	Submission has been amended	No
2015-09-01	This submission is the final filing	No
2015-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-09-01	Plan is a collectively bargained plan	No
2015-09-01	Plan funding arrangement – Insurance	Yes
2015-09-01	Plan benefit arrangement – Insurance	Yes
2014: DATA INTENSITY, LLC MEDICAL PLAN 2014 form 5500 responses
2014-09-01	Type of plan entity	Single employer plan
2014-09-01	First time form 5500 has been submitted	Yes
2014-09-01	Submission has been amended	No
2014-09-01	This submission is the final filing	No
2014-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-09-01	Plan is a collectively bargained plan	No
2014-09-01	Plan funding arrangement – Insurance	Yes
2014-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4957830

Policy instance

Insurance contract or identification number	4957830
Number of Individuals Covered	553
Insurance policy start date	2015-09-01
Insurance policy end date	2016-08-31
Total amount of commissions paid to insurance broker	USD $98,410
Total amount of fees paid to insurance company	USD $11,210
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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $98,410
Amount paid for insurance broker fees	11210
Additional information about fees paid to insurance broker	BONUS PERSISTENCY COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	COSTELLO BENEFITS GROUP

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )

Policy contract number

4957830

Policy instance

Insurance contract or identification number	4957830
Number of Individuals Covered	544
Insurance policy start date	2014-09-01
Insurance policy end date	2015-08-31
Total amount of commissions paid to insurance broker	USD $92,404
Total amount of fees paid to insurance company	USD $21,808
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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $92,404
Amount paid for insurance broker fees	21808
Additional information about fees paid to insurance broker	BONUS PERSISTENCY COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	COSTELLO BENEFITS GROUP

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Company Name:	DATA INTENSITY, LLC
Employer identification number (EIN):	043567891
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	201511310275

Plan id#	Filing Submission Date	Name of Administrator
504	2015-09-01	STACEY KARACEK
504	2015-09-01
504	2014-09-01	KEVIN SHONE