401k Plan data: TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN plan

TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN 401k Plan overview

Plan Name	TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN
Plan identification number	503

TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

ASPIRE ALLERGY & SINUS has sponsored the creation of one or more 401k plans.

Company Name: ASPIRE ALLERGY & SINUS

Employer identification number (EIN): 462952579

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Additional information about ASPIRE ALLERGY & SINUS

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2013-06-10

Company Identification Number: 0801798367

Legal Registered Office Address: 5929 BALCONES DR STE 200

AUSTIN
United States of America (USA)
78731

More information about ASPIRE ALLERGY & SINUS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2019-01-01 KELSEY HAMILTON 2020-06-17
503 2019-01-01 KELSEY HAMILTON 2021-07-28
503 2018-01-01 KELSEY HAMILTON 2020-06-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2019-01-01	KELSEY HAMILTON	2020-06-17
503	2019-01-01	KELSEY HAMILTON	2021-07-28
503	2018-01-01	KELSEY HAMILTON	2020-06-17

Plan Statistics for TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN

401k plan membership statisitcs for TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN

Measure Date Value
2019: TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 66
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 66
Number of employers contributing to the scheme 2019-01-01 0
2018: TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 31
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 39
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 39
Number of employers contributing to the scheme 2018-01-01 0

Measure	Date	Value
2019: TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	66
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	66
Number of employers contributing to the scheme	2019-01-01	0
2018: TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	39
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	39
Number of employers contributing to the scheme	2018-01-01	0

Form 5500 Responses for TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN

2019: TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Mulitple employer plan
2019-01-01	Submission has been amended	Yes
2019-01-01	This submission is the final filing	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: TEXAN ALLERGY SHORT TERM DISABILITY BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Mulitple employer plan
2018-01-01	First time form 5500 has been submitted	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F015348

Policy instance

Insurance contract or identification number	F015348
Number of Individuals Covered	173
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $2,015
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,007
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F015348

Policy instance

Insurance contract or identification number	F015348
Number of Individuals Covered	107
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $1,712
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $856
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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Company Name:	ASPIRE ALLERGY & SINUS
Employer identification number (EIN):	462952579
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2013-06-10
Company Identification Number:	0801798367
Legal Registered Office Address:	5929 BALCONES DR STE 200 AUSTIN United States of America (USA) 78731