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PAVLOV MEDIA HEALTH AND WELFARE PLAN 401k Plan overview

Plan NamePAVLOV MEDIA HEALTH AND WELFARE PLAN
Plan identification number 501

PAVLOV MEDIA HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

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

Company Name:PAVLOV MEDIA, INC.
Employer identification number (EIN):300239661
NAIC Classification:517000

Additional information about PAVLOV MEDIA, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2004-09-07
Company Identification Number: 0800385771
Legal Registered Office Address: PO BOX 25

CHAMPAIGN
United States of America (USA)
61824

More information about PAVLOV MEDIA, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PAVLOV MEDIA HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01LISA FRANZEN2023-07-10
5012021-01-01LISA FRANZEN2022-07-19
5012020-01-01LISA FRANZEN2021-07-15
5012019-01-01LISA FRANZEN2020-10-09
5012018-01-01LISA FRANZEN2020-10-09

Plan Statistics for PAVLOV MEDIA HEALTH AND WELFARE PLAN

401k plan membership statisitcs for PAVLOV MEDIA HEALTH AND WELFARE PLAN

Measure Date Value
2022: PAVLOV MEDIA HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01204
Total number of active participants reported on line 7a of the Form 55002022-01-01208
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01208
Number of employers contributing to the scheme2022-01-010
2021: PAVLOV MEDIA HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01208
Total number of active participants reported on line 7a of the Form 55002021-01-01204
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01204
Number of employers contributing to the scheme2021-01-010
2020: PAVLOV MEDIA HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01168
Total number of active participants reported on line 7a of the Form 55002020-01-01179
Number of retired or separated participants receiving benefits2020-01-011
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01180
Number of employers contributing to the scheme2020-01-010
2019: PAVLOV MEDIA HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01134
Total number of active participants reported on line 7a of the Form 55002019-01-01167
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01168
Number of employers contributing to the scheme2019-01-010
2018: PAVLOV MEDIA HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01102
Total number of active participants reported on line 7a of the Form 55002018-01-01124
Number of retired or separated participants receiving benefits2018-01-011
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01125
Number of employers contributing to the scheme2018-01-010

Form 5500 Responses for PAVLOV MEDIA HEALTH AND WELFARE PLAN

2022: PAVLOV MEDIA HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: PAVLOV MEDIA HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: PAVLOV MEDIA HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: PAVLOV MEDIA HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: PAVLOV MEDIA HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01First time form 5500 has been submittedYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number239551
Policy instance 4
Insurance contract or identification number239551
Number of Individuals Covered208
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,946
Total amount of fees paid to insurance companyUSD $8,112
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM,ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $98,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,946
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number1009889
Policy instance 3
Insurance contract or identification number1009889
Number of Individuals Covered333
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,710
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,710
Amount paid for insurance broker fees0
Insurance broker organization code?3
KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )
Policy contract number23842
Policy instance 2
Insurance contract or identification number23842
Number of Individuals Covered178
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $13,061
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $132,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,061
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number246131
Policy instance 1
Insurance contract or identification number246131
Number of Individuals Covered355
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $57,389
Total amount of fees paid to insurance companyUSD $1,740
Health Insurance Welfare BenefitYes
Other welfare benefits providedTELEHEALTH
Welfare Benefit Premiums Paid to CarrierUSD $2,305,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $57,389
Amount paid for insurance broker fees1740
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number239551
Policy instance 4
Insurance contract or identification number239551
Number of Individuals Covered216
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $11,854
Total amount of fees paid to insurance companyUSD $7,425
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM,ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $102,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,854
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number1009889
Policy instance 3
Insurance contract or identification number1009889
Number of Individuals Covered325
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,851
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,851
Amount paid for insurance broker fees0
Insurance broker organization code?3
KANSAS CITY LIFE (National Association of Insurance Commissioners NAIC id number: 65129 )
Policy contract number23842
Policy instance 2
Insurance contract or identification number23842
Number of Individuals Covered180
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $14,045
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $140,025
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,045
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number246131
Policy instance 1
Insurance contract or identification number246131
Number of Individuals Covered349
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $59,294
Total amount of fees paid to insurance companyUSD $1,820
Health Insurance Welfare BenefitYes
Other welfare benefits providedTELEHEALTH
Welfare Benefit Premiums Paid to CarrierUSD $2,360,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,294
Amount paid for insurance broker fees1820
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 numberPJ1413 PJ1414
Policy instance 1
Insurance contract or identification numberPJ1413 PJ1414
Number of Individuals Covered360
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $37,908
Total amount of fees paid to insurance companyUSD $71,840
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,256,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $22,821
Amount paid for insurance broker fees71840
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberPJ1413 PJ1414
Policy instance 1
Insurance contract or identification numberPJ1413 PJ1414
Number of Individuals Covered330
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $104,140
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,979,748
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $76,705
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOTHER COMMISSIONS
HEALTH ALLIANCE MEDICAL PLANS (National Association of Insurance Commissioners NAIC id number: 77950 )
Policy contract number002597
Policy instance 1
Insurance contract or identification number002597
Number of Individuals Covered278
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $64,200
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,522,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $64,200
Amount paid for insurance broker fees0
Insurance broker organization code?3

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