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| Plan Name | US PAIN & SPINE INSTITUTE WELFARE BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | US PAIN & SPINE INSTITUTE, LLC |
| Employer identification number (EIN): | 464651260 |
| NAIC Classification: | 621399 |
| NAIC Description: | Offices of All Other Miscellaneous Health Practitioners |
Additional information about US PAIN & SPINE INSTITUTE, LLC
| Jurisdiction of Incorporation: | Texas Secretary of State |
| Incorporation Date: | 2013-08-09 |
| Company Identification Number: | 0801832319 |
| Legal Registered Office Address: |
PO BOX 772569 HOUSTON United States of America (USA) 77215 |
More information about US PAIN & SPINE INSTITUTE, LLC
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2017-10-01 | ||||
| 501 | 2016-10-01 | ||||
| 501 | 2015-10-01 | SONYA ATKINS |
| Measure | Date | Value |
|---|---|---|
| 2017: US PAIN & SPINE INSTITUTE WELFARE BENEFIT PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-10-01 | 250 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 264 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
| Total of all active and inactive participants | 2017-10-01 | 265 |
| 2016: US PAIN & SPINE INSTITUTE WELFARE BENEFIT PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-10-01 | 236 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 249 |
| Number of retired or separated participants receiving benefits | 2016-10-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
| Total of all active and inactive participants | 2016-10-01 | 254 |
| 2015: US PAIN & SPINE INSTITUTE WELFARE BENEFIT PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-10-01 | 237 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 230 |
| Number of retired or separated participants receiving benefits | 2015-10-01 | 6 |
| Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
| Total of all active and inactive participants | 2015-10-01 | 236 |
| 2017: US PAIN & SPINE INSTITUTE WELFARE BENEFIT PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Submission has been amended | No |
| 2017-10-01 | This submission is the final filing | No |
| 2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2017-10-01 | Plan is a collectively bargained plan | No |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: US PAIN & SPINE INSTITUTE WELFARE BENEFIT PLAN 2016 form 5500 responses | ||
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Submission has been amended | No |
| 2016-10-01 | This submission is the final filing | No |
| 2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-10-01 | Plan is a collectively bargained plan | No |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: US PAIN & SPINE INSTITUTE WELFARE BENEFIT PLAN 2015 form 5500 responses | ||
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Submission has been amended | No |
| 2015-10-01 | This submission is the final filing | No |
| 2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-10-01 | Plan is a collectively bargained plan | No |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 5473121 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 0909314 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| UNITED DENTAL CARE OF TEXAS INC (National Association of Insurance Commissioners NAIC id number: 95142 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 5473121 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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