401k Plan data: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN plan

OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number	502

OMNIA ITALIAN DESIGN EMPLOYEE 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) Other welfare benefit cover

401k Sponsoring company profile

OMNIA ITALIAN DESIGN, LLC has sponsored the creation of one or more 401k plans.

Company Name: OMNIA ITALIAN DESIGN, LLC

Employer identification number (EIN): 330352016

NAIC Classification: 337000

Additional information about OMNIA ITALIAN DESIGN, LLC

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C1560879

More information about OMNIA ITALIAN DESIGN, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-06-01 VIRGINIA ARAGON 2024-11-12
502 2022-06-01 VIRGINIA ARAGON 2023-12-14
502 2021-06-01 VIRGINIA ARAGON 2022-12-28
502 2020-06-01 VIRGINIA ARAGON 2021-12-16
502 2019-06-01
502 2018-06-01
502 2017-10-01 FRANK SCHNEIDER
502 2016-10-01
502 2015-10-01
502 2014-10-01 FRANK SCHNEIDER
502 2013-10-01 FRANK SCHNEIDER
502 2012-10-01 FRANK SCHNEIDER
502 2011-10-01 FRANK SCHNEIDER
502 2010-10-01 FRANK SCHNEIDER
502 2009-10-01 FRANK SCHNEIDER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2023-06-01	VIRGINIA ARAGON	2024-11-12
502	2022-06-01	VIRGINIA ARAGON	2023-12-14
502	2021-06-01	VIRGINIA ARAGON	2022-12-28
502	2020-06-01	VIRGINIA ARAGON	2021-12-16
502	2019-06-01
502	2018-06-01
502	2017-10-01	FRANK SCHNEIDER
502	2016-10-01
502	2015-10-01
502	2014-10-01	FRANK SCHNEIDER
502	2013-10-01	FRANK SCHNEIDER
502	2012-10-01	FRANK SCHNEIDER
502	2011-10-01	FRANK SCHNEIDER
502	2010-10-01	FRANK SCHNEIDER
502	2009-10-01	FRANK SCHNEIDER

Form 5500 Responses for OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN

2023: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-06-01	Type of plan entity	Single employer plan
2023-06-01	Plan funding arrangement – Insurance	Yes
2023-06-01	Plan benefit arrangement – Insurance	Yes
2022: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-06-01	Type of plan entity	Single employer plan
2022-06-01	Plan funding arrangement – Insurance	Yes
2022-06-01	Plan benefit arrangement – Insurance	Yes
2021: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-06-01	Type of plan entity	Single employer plan
2021-06-01	Plan funding arrangement – Insurance	Yes
2021-06-01	Plan benefit arrangement – Insurance	Yes
2020: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-06-01	Type of plan entity	Single employer plan
2020-06-01	Plan funding arrangement – Insurance	Yes
2020-06-01	Plan benefit arrangement – Insurance	Yes
2019: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-06-01	Type of plan entity	Single employer plan
2019-06-01	Submission has been amended	No
2019-06-01	This submission is the final filing	No
2019-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-06-01	Plan is a collectively bargained plan	No
2019-06-01	Plan funding arrangement – Insurance	Yes
2019-06-01	Plan benefit arrangement – Insurance	Yes
2018: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-06-01	Type of plan entity	Single employer plan
2018-06-01	Submission has been amended	No
2018-06-01	This submission is the final filing	No
2018-06-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-06-01	Plan is a collectively bargained plan	No
2018-06-01	Plan funding arrangement – Insurance	Yes
2018-06-01	Plan benefit arrangement – Insurance	Yes
2017: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	Submission has been amended	No
2017-10-01	This submission is the final filing	No
2017-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-10-01	Plan is a collectively bargained plan	No
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes
2016: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-10-01	Type of plan entity	Single employer plan
2016-10-01	Submission has been amended	No
2016-10-01	This submission is the final filing	No
2016-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-10-01	Plan is a collectively bargained plan	No
2016-10-01	Plan funding arrangement – Insurance	Yes
2016-10-01	Plan benefit arrangement – Insurance	Yes
2015: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	No
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan benefit arrangement – Insurance	Yes
2014: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan benefit arrangement – Insurance	Yes
2013: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	No
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan benefit arrangement – Insurance	Yes
2012: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	No
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan benefit arrangement – Insurance	Yes
2011: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	No
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan benefit arrangement – Insurance	Yes
2010: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	Submission has been amended	No
2010-10-01	This submission is the final filing	No
2010-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-10-01	Plan is a collectively bargained plan	No
2010-10-01	Plan funding arrangement – Insurance	Yes
2010-10-01	Plan benefit arrangement – Insurance	Yes
2009: OMNIA ITALIAN DESIGN EMPLOYEE WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	First time form 5500 has been submitted	Yes
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

281737

Policy instance

Insurance contract or identification number	281737
Number of Individuals Covered	254
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $60,899
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life 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 $1,094,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ERS07

Policy instance

Insurance contract or identification number	ERS07
Number of Individuals Covered	99
Insurance policy start date	2023-06-01
Insurance policy end date	2024-05-31
Total amount of commissions paid to insurance broker	USD $8,738
Total amount of fees paid to insurance company	USD $237
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to Carrier	USD $60,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

281737

Policy instance

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ERS07

Policy instance

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

281737

Policy instance

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ERS07

Policy instance

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

281737

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

530282

Policy instance

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ERS07

Policy instance

AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )

Policy contract number

ERS07

Policy instance

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

281737

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

530282

Policy instance

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

281737

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

530282

Policy instance

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

530282

Policy instance

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 95567 )

Policy contract number

L7002A

Policy instance

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

151356

Policy instance

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 95567 )

Policy contract number

L7002A

Policy instance

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

151356

Policy instance

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

151356

Policy instance

HEALTH NET (National Association of Insurance Commissioners NAIC id number: 95567 )

Policy contract number

L7002A

Policy instance

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

151356

Policy instance

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

151356

Policy instance

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

151356

Policy instance

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

151356

Policy instance

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

151356

Policy instance

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

151356

Policy instance

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

151356

Policy instance

BLUE CROSS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

151356

Policy instance

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Company Name:	OMNIA ITALIAN DESIGN, LLC
Employer identification number (EIN):	330352016
NAIC Classification:	337000

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C1560879