401k Plan data: ARTEMIS LIFESTYLES SERVICES, INC. WELFARE BENEFIT PLAN plan

ARTEMIS LIFESTYLES SERVICES, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	ARTEMIS LIFESTYLES SERVICES, INC. WELFARE BENEFIT PLAN
Plan identification number	501

ARTEMIS LIFESTYLES SERVICES, INC. WELFARE BENEFIT PLAN 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)

401k Sponsoring company profile

ARTEMIS LIFESTYLES SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name: ARTEMIS LIFESTYLES SERVICES, INC.

Employer identification number (EIN): 813450405

NAIC Classification: 531310

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ARTEMIS LIFESTYLES SERVICES, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 JUDY CABAN 2024-06-24
501 2022-01-01 JUDY CABAN 2023-05-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	JUDY CABAN	2024-06-24
501	2022-01-01	JUDY CABAN	2023-05-10

Form 5500 Responses for ARTEMIS LIFESTYLES SERVICES, INC. WELFARE BENEFIT PLAN

2023: ARTEMIS LIFESTYLES SERVICES, INC. WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2022: ARTEMIS LIFESTYLES SERVICES, INC. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 )

Policy contract number

J1769

Policy instance

Insurance contract or identification number	J1769
Number of Individuals Covered	44
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $20,192
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1056973

Policy instance

Insurance contract or identification number	1056973
Number of Individuals Covered	194
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $9,257
Total amount of fees paid to insurance company	USD $1,585
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $94,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 )

Policy contract number

J1769

Policy instance

Insurance contract or identification number	J1769
Number of Individuals Covered	20
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $5,153
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

926816

Policy instance

Insurance contract or identification number	926816
Number of Individuals Covered	68
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $16,763
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $445,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1056973

Policy instance

Insurance contract or identification number	1056973
Number of Individuals Covered	129
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,433
Total amount of fees paid to insurance company	USD $1,916
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $77,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ARTEMIS LIFESTYLES SERVICES, INC.
Employer identification number (EIN):	813450405
NAIC Classification:	531310