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| Plan Name | PHANTOM ADMINISTRATIVE, LLC GROUP LIFE, ACCIDENTAL DEATH, DISABILITY INSURANCE |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PHANTOM ADMINISTRATIVE LLC |
| Employer identification number (EIN): | 814654467 |
| NAIC Classification: | 424990 |
| NAIC Description: | Other Miscellaneous Nondurable Goods Merchant Wholesalers |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2023-01-01 | RYAN HUTCHINSON | 2024-10-14 | ||
| 503 | 2022-01-01 | PETER S FRANK | 2024-04-02 | ||
| 503 | 2021-01-01 | PETER FRANK | 2022-07-11 | ||
| 503 | 2020-01-01 | JASON LAPINA | 2021-10-14 | ||
| 503 | 2019-01-01 | JASON LAPINA | 2020-10-15 | ||
| 503 | 2018-01-01 | H. KEVIN HENCHAR | 2019-10-15 | ||
| 503 | 2017-01-01 |
| 2023: PHANTOM ADMINISTRATIVE, LLC GROUP LIFE, ACCIDENTAL DEATH, DISABILITY INSURANCE 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: PHANTOM ADMINISTRATIVE, LLC GROUP LIFE, ACCIDENTAL DEATH, DISABILITY INSURANCE 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: PHANTOM ADMINISTRATIVE, LLC GROUP LIFE, ACCIDENTAL DEATH, DISABILITY INSURANCE 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: PHANTOM ADMINISTRATIVE, LLC GROUP LIFE, ACCIDENTAL DEATH, DISABILITY INSURANCE 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: PHANTOM ADMINISTRATIVE, LLC GROUP LIFE, ACCIDENTAL DEATH, DISABILITY INSURANCE 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: PHANTOM ADMINISTRATIVE, LLC GROUP LIFE, ACCIDENTAL DEATH, DISABILITY INSURANCE 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: PHANTOM ADMINISTRATIVE, LLC GROUP LIFE, ACCIDENTAL DEATH, DISABILITY INSURANCE 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |||||||||||||||||||||||
| Policy contract number | AL00005260 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |||||||||||||||||||||||
| Policy contract number | AL00005260 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |||||||||||||||||||||||
| Policy contract number | AL00005260 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |||||||||||||||||||||||
| Policy contract number | AL00005260 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |||||||||||||||||||||||
| Policy contract number | AL00005260 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |||||||||||||||||||||||
| Policy contract number | AL00005260 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) | |||||||||||||||||||||||
| Policy contract number | AL00005260 | ||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||
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