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XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN 401k Plan overview

Plan NameXPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN
Plan identification number 501

XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

XPERIENCE MANAGEMENT GROUP LLC has sponsored the creation of one or more 401k plans.

Company Name:XPERIENCE MANAGEMENT GROUP LLC
Employer identification number (EIN):471335785
NAIC Classification:713900

Additional information about XPERIENCE MANAGEMENT GROUP LLC

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 2013-09-18
Company Identification Number: 20131552807
Legal Registered Office Address: 2005 CEDAR HILLS ST

LAS VEGAS
United States of America (USA)
89128

More information about XPERIENCE MANAGEMENT GROUP LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-11-01
5012018-11-01
5012017-11-01
5012016-11-01DENA BARTON DENA BARTON2018-07-09

Plan Statistics for XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN

401k plan membership statisitcs for XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN

Measure Date Value
2019: XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-0184
Total number of active participants reported on line 7a of the Form 55002019-11-0151
Number of retired or separated participants receiving benefits2019-11-010
Number of other retired or separated participants entitled to future benefits2019-11-010
Total of all active and inactive participants2019-11-0151
2018: XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-0191
Total number of active participants reported on line 7a of the Form 55002018-11-0184
Total of all active and inactive participants2018-11-0184
2017: XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-01101
Total number of active participants reported on line 7a of the Form 55002017-11-0191
Number of retired or separated participants receiving benefits2017-11-011
Number of other retired or separated participants entitled to future benefits2017-11-010
Total of all active and inactive participants2017-11-0192
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-11-010
2016: XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-01103
Total number of active participants reported on line 7a of the Form 55002016-11-0199
Number of retired or separated participants receiving benefits2016-11-013
Total of all active and inactive participants2016-11-01102

Form 5500 Responses for XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN

2019: XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Submission has been amendedNo
2019-11-01This submission is the final filingNo
2019-11-01This return/report is a short plan year return/report (less than 12 months)No
2019-11-01Plan is a collectively bargained planNo
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan benefit arrangement – InsuranceYes
2018: XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Submission has been amendedNo
2018-11-01This submission is the final filingNo
2018-11-01This return/report is a short plan year return/report (less than 12 months)No
2018-11-01Plan is a collectively bargained planNo
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan benefit arrangement – InsuranceYes
2017: XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Submission has been amendedNo
2017-11-01This submission is the final filingNo
2017-11-01This return/report is a short plan year return/report (less than 12 months)No
2017-11-01Plan is a collectively bargained planNo
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan benefit arrangement – InsuranceYes
2016: XPERIENCE MANAGEMENT GROUP LLC MEDICAL PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01First time form 5500 has been submittedYes
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 95342 )
Policy contract number774304
Policy instance 1
Insurance contract or identification number774304
Number of Individuals Covered42
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $16,734
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $415,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,734
Insurance broker organization code?3
HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 95342 )
Policy contract number774304
Policy instance 1
Insurance contract or identification number774304
Number of Individuals Covered84
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $20,660
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $592,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,660
Insurance broker organization code?3
HUMANA WISCONSIN HEALTH ORGANIZATION INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 95342 )
Policy contract number774304
Policy instance 1
Insurance contract or identification number774304
Number of Individuals Covered96
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $25,342
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $455,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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