401k Plan data: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN plan

LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 401k Plan overview

Plan Name	LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN
Plan identification number	501

LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN Benefits

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

401k Sponsoring company profile

LAGNIAPPE HEALTH ACQUISITION COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: LAGNIAPPE HEALTH ACQUISITION COMPANY, INC.

Employer identification number (EIN): 200030949

NAIC Classification: 541519
NAIC Description: Other Computer Related Services

Additional information about LAGNIAPPE HEALTH ACQUISITION COMPANY, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2003-08-04

Company Identification Number: 0800231509

Legal Registered Office Address: 4224 NORTH FWY

FORT WORTH
United States of America (USA)
76137

More information about LAGNIAPPE HEALTH ACQUISITION COMPANY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-07-01 LORI MCDANIEL LORI MCDANIEL 2018-02-05
501 2015-07-01 JACOB CANOVA
501 2014-07-01 JACOB CANOVA
501 2013-07-01 JACOB CANOVA
501 2012-07-01 JACOB CANOVA

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2016-07-01	LORI MCDANIEL	LORI MCDANIEL	2018-02-05
501	2015-07-01	JACOB CANOVA
501	2014-07-01	JACOB CANOVA
501	2013-07-01	JACOB CANOVA
501	2012-07-01	JACOB CANOVA

Plan Statistics for LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN

401k plan membership statisitcs for LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN

Measure Date Value
2016: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 175
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 0
Total of all active and inactive participants 2016-07-01 0
2015: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 189
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 175
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 175
2014: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 193
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 183
Number of retired or separated participants receiving benefits 2014-07-01 6
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 189
2013: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 151
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 191
Number of retired or separated participants receiving benefits 2013-07-01 2
Number of other retired or separated participants entitled to future benefits 2013-07-01 0
Total of all active and inactive participants 2013-07-01 193
2012: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-07-01 137
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 151
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 151

Measure	Date	Value
2016: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	175
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	0
Total of all active and inactive participants	2016-07-01	0
2015: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	189
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	175
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	175
2014: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	193
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	183
Number of retired or separated participants receiving benefits	2014-07-01	6
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	189
2013: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	151
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	191
Number of retired or separated participants receiving benefits	2013-07-01	2
Number of other retired or separated participants entitled to future benefits	2013-07-01	0
Total of all active and inactive participants	2013-07-01	193
2012: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-07-01	137
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	151
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	151

Form 5500 Responses for LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN

2016: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: LAGNIAPPE HEALTH ACQUISITION HEALTH PLAN 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

602550

Policy instance

Insurance contract or identification number	602550
Number of Individuals Covered	290
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $95,505
Total amount of fees paid to insurance company	USD $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 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 $1,758,338
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $95,505
Insurance broker organization code?	3
Insurance broker name	THE WILSHIRE GROUP LLC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

602550

Policy instance

Insurance contract or identification number	602550
Number of Individuals Covered	296
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $98,147
Total amount of fees paid to insurance company	USD $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 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 $1,870,659
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $98,147
Insurance broker organization code?	3
Insurance broker name	THE WILSHIRE GROUP LLC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

602550

Policy instance

Insurance contract or identification number	602550
Number of Individuals Covered	302
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $85,298
Total amount of fees paid to insurance company	USD $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 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 $1,711,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $85,298
Insurance broker organization code?	3
Insurance broker name	THE WILSHIRE GROUP LLC

OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

RP15413

Policy instance

Insurance contract or identification number	RP15413
Number of Individuals Covered	130
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $42,492
Total amount of fees paid to insurance company	USD $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 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 $917,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,132
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

602550

Policy instance

Insurance contract or identification number	602550
Number of Individuals Covered	151
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $38,561
Total amount of fees paid to insurance company	USD $500
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
Welfare Benefit Premiums Paid to Carrier	USD $735,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,748
Insurance broker organization code?	3
Amount paid for insurance broker fees	500
Additional information about fees paid to insurance broker	2012 MEDICAL RETENTION SUPPLEMENTAL COMPENSATION
Insurance broker name	LOCKTON COMPANIES LLC

Potentially related plans

LAGNIAPPE HEALTHCARE, LLC 401(K) PLAN [EIN = 262967959]

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Company Name:	LAGNIAPPE HEALTH ACQUISITION COMPANY, INC.
Employer identification number (EIN):	200030949
NAIC Classification:	541519
NAIC Description:	Other Computer Related Services

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2003-08-04
Company Identification Number:	0800231509
Legal Registered Office Address:	4224 NORTH FWY FORT WORTH United States of America (USA) 76137