401k Plan data: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN plan

FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 401k Plan overview

Plan Name	FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN
Plan identification number	506

FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Temporary disability (accident and sickness)

401k Sponsoring company profile

FRONTLINE ANTERRA, LLC has sponsored the creation of one or more 401k plans.

Company Name: FRONTLINE ANTERRA, LLC

Employer identification number (EIN): 825050121

NAIC Classification: 531310

Additional information about FRONTLINE ANTERRA, LLC

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2018-04-06

Company Identification Number: 0802983647

Legal Registered Office Address: 12400 COIT RD STE 600

DALLAS
United States of America (USA)
75251

More information about FRONTLINE ANTERRA, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2020-12-30
506 2019-12-30
506 2018-12-30
506 2017-12-30

Plan Statistics for FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN

401k plan membership statisitcs for FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN

Measure Date Value
2020: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-12-30 133
Total number of active participants reported on line 7a of the Form 5500 2020-12-30 130
Total of all active and inactive participants 2020-12-30 130
Total participants 2020-12-30 130
2019: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-12-30 164
Total number of active participants reported on line 7a of the Form 5500 2019-12-30 133
Total of all active and inactive participants 2019-12-30 133
Total participants 2019-12-30 133
2018: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-12-30 151
Total number of active participants reported on line 7a of the Form 5500 2018-12-30 164
Total of all active and inactive participants 2018-12-30 164
Total participants 2018-12-30 164
2017: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-12-30 211
Total number of active participants reported on line 7a of the Form 5500 2017-12-30 161
Total of all active and inactive participants 2017-12-30 161
Total participants 2017-12-30 161

Measure	Date	Value
2020: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-12-30	133
Total number of active participants reported on line 7a of the Form 5500	2020-12-30	130
Total of all active and inactive participants	2020-12-30	130
Total participants	2020-12-30	130
2019: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-12-30	164
Total number of active participants reported on line 7a of the Form 5500	2019-12-30	133
Total of all active and inactive participants	2019-12-30	133
Total participants	2019-12-30	133
2018: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-12-30	151
Total number of active participants reported on line 7a of the Form 5500	2018-12-30	164
Total of all active and inactive participants	2018-12-30	164
Total participants	2018-12-30	164
2017: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-12-30	211
Total number of active participants reported on line 7a of the Form 5500	2017-12-30	161
Total of all active and inactive participants	2017-12-30	161
Total participants	2017-12-30	161

Form 5500 Responses for FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN

2020: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2020 form 5500 responses
2020-12-30	Type of plan entity	Single employer plan
2020-12-30	Submission has been amended	No
2020-12-30	This submission is the final filing	No
2020-12-30	This return/report is a short plan year return/report (less than 12 months)	No
2020-12-30	Plan is a collectively bargained plan	No
2020-12-30	Plan funding arrangement – Insurance	Yes
2020-12-30	Plan benefit arrangement – Insurance	Yes
2019: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2019 form 5500 responses
2019-12-30	Type of plan entity	Single employer plan
2019-12-30	Submission has been amended	No
2019-12-30	This submission is the final filing	No
2019-12-30	This return/report is a short plan year return/report (less than 12 months)	No
2019-12-30	Plan is a collectively bargained plan	No
2019-12-30	Plan funding arrangement – Insurance	Yes
2019-12-30	Plan benefit arrangement – Insurance	Yes
2018: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2018 form 5500 responses
2018-12-30	Type of plan entity	Single employer plan
2018-12-30	First time form 5500 has been submitted	Yes
2018-12-30	Submission has been amended	No
2018-12-30	This submission is the final filing	No
2018-12-30	This return/report is a short plan year return/report (less than 12 months)	No
2018-12-30	Plan is a collectively bargained plan	No
2018-12-30	Plan funding arrangement – Insurance	Yes
2018-12-30	Plan benefit arrangement – Insurance	Yes
2017: FRONTLINE ANTERRA EMPLOYEE INJURY BENEFIT PLAN 2017 form 5500 responses
2017-12-30	Type of plan entity	Single employer plan
2017-12-30	First time form 5500 has been submitted	Yes
2017-12-30	Submission has been amended	No
2017-12-30	This submission is the final filing	No
2017-12-30	This return/report is a short plan year return/report (less than 12 months)	No
2017-12-30	Plan is a collectively bargained plan	No
2017-12-30	Plan funding arrangement – Insurance	Yes
2017-12-30	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

NORTH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 25038 )

Policy contract number

EEG130022

Policy instance

Insurance contract or identification number	EEG130022
Number of Individuals Covered	130
Insurance policy start date	2020-12-30
Insurance policy end date	2021-12-30
Total amount of commissions paid to insurance broker	USD $24,034
Total amount of fees paid to insurance company	USD $9,200
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $123,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,407
Amount paid for insurance broker fees	1000
Additional information about fees paid to insurance broker	FEES

NORTH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 25038 )

Policy contract number

EEG120022

Policy instance

Insurance contract or identification number	EEG120022
Number of Individuals Covered	133
Insurance policy start date	2019-12-30
Insurance policy end date	2020-12-30
Total amount of commissions paid to insurance broker	USD $24,462
Total amount of fees paid to insurance company	USD $10,200
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $125,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,681
Amount paid for insurance broker fees	3000
Additional information about fees paid to insurance broker	FEES

NORTH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 25038 )

Policy contract number

EEG110022

Policy instance

Insurance contract or identification number	EEG110022
Number of Individuals Covered	164
Insurance policy start date	2018-12-30
Insurance policy end date	2019-12-30
Total amount of commissions paid to insurance broker	USD $25,422
Total amount of fees paid to insurance company	USD $11,200
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1000
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $9,126

NORTH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 25038 )

Policy contract number

EEG100022

Policy instance

Insurance contract or identification number	EEG100022
Number of Individuals Covered	161
Insurance policy start date	2017-12-30
Insurance policy end date	2018-12-30
Total amount of commissions paid to insurance broker	USD $26,315
Total amount of fees paid to insurance company	USD $11,200
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	FRONTLINE ANTERRA, LLC
Employer identification number (EIN):	825050121
NAIC Classification:	531310

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2018-04-06
Company Identification Number:	0802983647
Legal Registered Office Address:	12400 COIT RD STE 600 DALLAS United States of America (USA) 75251