401k Plan data: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN plan

ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 401k Plan overview

Plan Name	ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN
Plan identification number	522

ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision

401k Sponsoring company profile

ROLEX WATCH U.S.A., INC. has sponsored the creation of one or more 401k plans.

Company Name: ROLEX WATCH U.S.A., INC.

Employer identification number (EIN): 131574389

NAIC Classification: 423990
NAIC Description: Other Miscellaneous Durable Goods Merchant Wholesalers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
522 2023-01-01 MARK GOLDBERG 2024-09-12
522 2022-01-01 MARK GOLDBERG 2023-09-20
522 2021-01-01
522 2021-01-01 MARK W. GOLDBERG
522 2020-01-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
522	2023-01-01	MARK GOLDBERG	2024-09-12
522	2022-01-01	MARK GOLDBERG	2023-09-20
522	2021-01-01
522	2021-01-01	MARK W. GOLDBERG
522	2020-01-01

Plan Statistics for ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN

401k plan membership statisitcs for ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN

Measure Date Value
2023: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 151
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 205
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 205
Number of employers contributing to the scheme 2023-01-01 0
2022: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 150
Number of retired or separated participants receiving benefits 2022-01-01 1
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 151
2021: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 127
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 127
2020: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 105
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 105

Measure	Date	Value
2023: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	151
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	205
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	205
Number of employers contributing to the scheme	2023-01-01	0
2022: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	150
Number of retired or separated participants receiving benefits	2022-01-01	1
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	151
2021: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	127
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	127
2020: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	105
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	105

Form 5500 Responses for ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN

2023: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION 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: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2020: ROLEX WATCH U. S. A., INC. SUPPLEMENTAL VISION PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	First time form 5500 has been submitted	Yes
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

Z2Y-001 002

Policy instance

Insurance contract or identification number	Z2Y-001 002
Number of Individuals Covered	419
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

Z2Y-001 002

Policy instance

Insurance contract or identification number	Z2Y-001 002
Number of Individuals Covered	290
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $11,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

Z2Y-001 002

Policy instance

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )

Policy contract number

Z2Y-001 002

Policy instance

Potentially related plans

ROLEX WATCH U.S.A., INC. RETIREE MEDICAL PLAN [EIN = 206740815]

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Company Name:	ROLEX WATCH U.S.A., INC.
Employer identification number (EIN):	131574389
NAIC Classification:	423990
NAIC Description:	Other Miscellaneous Durable Goods Merchant Wholesalers