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| Plan Name | PAYER MATRIX HEALTH AND WELFARE PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PAYER MATRIX LLC |
| Employer identification number (EIN): | 813946362 |
| NAIC Classification: | 541990 |
| NAIC Description: | All Other Professional, Scientific, and Technical Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-12-01 | VANESSA JANES | 2024-06-13 |
| 2022: PAYER MATRIX HEALTH AND WELFARE PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-12-01 | Type of plan entity | Single employer plan |
| 2022-12-01 | First time form 5500 has been submitted | Yes |
| 2022-12-01 | Submission has been amended | No |
| 2022-12-01 | This submission is the final filing | No |
| 2022-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-12-01 | Plan is a collectively bargained plan | No |
| 2022-12-01 | Plan funding arrangement – Insurance | Yes |
| 2022-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) | |
| Policy contract number | 0002336427 |
| Policy instance | 1 |
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) | |
| Policy contract number | 657420 |
| Policy instance | 2 |
| PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 ) | |
| Policy contract number | 709613 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) | |
| Policy contract number | 417056 |
| Policy instance | 4 |
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