401k Plan data: HUMANA plan

HUMANA 401k Plan overview

Plan Name	HUMANA
Plan identification number	501

HUMANA Benefits

401k Plan Type	Welfare 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

FACE AMUSEMENT GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: FACE AMUSEMENT GROUP, LLC

Employer identification number (EIN): 462751352

NAIC Classification: 713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HUMANA

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 DEB CHRISTENSEN 2024-09-25

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	DEB CHRISTENSEN	2024-09-25

Plan Statistics for HUMANA

401k plan membership statisitcs for HUMANA

Measure Date Value
2023: HUMANA 2023 401k membership
Total participants, beginning-of-year 2023-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 213
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 213
Number of employers contributing to the scheme 2023-01-01 0

Measure	Date	Value
2023: HUMANA 2023 401k membership
Total participants, beginning-of-year	2023-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	213
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	213
Number of employers contributing to the scheme	2023-01-01	0

Form 5500 Responses for HUMANA

2023: HUMANA 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

853826

Policy instance

Insurance contract or identification number	853826
Number of Individuals Covered	127
Insurance policy start date	2023-01-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $37,333
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $761,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

56229

Policy instance

Insurance contract or identification number	56229
Number of Individuals Covered	71
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $18,616
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TELADOC, INC. (National Association of Insurance Commissioners NAIC id number: 52411 )

Policy contract number

293706

Policy instance

Insurance contract or identification number	293706
Number of Individuals Covered	298
Insurance policy start date	2023-01-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $1,768
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	TELEHEALTH
Welfare Benefit Premiums Paid to Carrier	USD $11,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )

Policy contract number

146585

Policy instance

Insurance contract or identification number	146585
Number of Individuals Covered	203
Insurance policy start date	2023-10-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $8,866
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,567
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RECURO HEALTH (National Association of Insurance Commissioners NAIC id number: 62199 )

Policy contract number

712738

Policy instance

Insurance contract or identification number	712738
Number of Individuals Covered	240
Insurance policy start date	2023-10-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $734
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	TELEHEALTH
Welfare Benefit Premiums Paid to Carrier	USD $4,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )

Policy contract number

7304

Policy instance

Insurance contract or identification number	7304
Number of Individuals Covered	218
Insurance policy start date	2023-01-01
Insurance policy end date	2023-09-30
Total amount of commissions paid to insurance broker	USD $6,854
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )

Policy contract number

10272884

Policy instance

Insurance contract or identification number	10272884
Number of Individuals Covered	213
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $27,836
Total amount of fees paid to insurance company	USD $4,498
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,CRITICAL ILLNESS,ACCIDENT,HOSPITAL,EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $74,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

Potentially related plans

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Company Name:	FACE AMUSEMENT GROUP, LLC
Employer identification number (EIN):	462751352
NAIC Classification:	713900