401k Plan data: TELA BIO, INC. WELFARE BENEFITS PLAN plan

TELA BIO, INC. WELFARE BENEFITS PLAN 401k Plan overview

Plan Name	TELA BIO, INC. WELFARE BENEFITS PLAN
Plan identification number	501

TELA BIO, INC. WELFARE BENEFITS 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

TELA BIO, INC. has sponsored the creation of one or more 401k plans.

Company Name: TELA BIO, INC.

Employer identification number (EIN): 455320061

NAIC Classification: 541700

Additional information about TELA BIO, INC.

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5141284

More information about TELA BIO, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TELA BIO, INC. WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 MEGAN SMEYKAL 2024-07-23
501 2022-01-01 MEGAN SMEYKAL 2023-07-19
501 2021-01-01 MEGAN SMEYKAL 2022-06-02
501 2021-01-01 MEGAN SMEYKAL 2023-07-19

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	MEGAN SMEYKAL	2024-07-23
501	2022-01-01	MEGAN SMEYKAL	2023-07-19
501	2021-01-01	MEGAN SMEYKAL	2022-06-02
501	2021-01-01	MEGAN SMEYKAL	2023-07-19

Form 5500 Responses for TELA BIO, INC. WELFARE BENEFITS PLAN

2023: TELA BIO, INC. WELFARE BENEFITS 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: TELA BIO, INC. WELFARE BENEFITS PLAN 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: TELA BIO, INC. WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Submission has been amended	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

627734

Policy instance

Insurance contract or identification number	627734
Number of Individuals Covered	281
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $11,045
Total amount of fees paid to insurance company	USD $6,311
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $157,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

1713254

Policy instance

Insurance contract or identification number	1713254
Number of Individuals Covered	465
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $118,407
Total amount of fees paid to insurance company	USD $5,893
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

166790

Policy instance

Insurance contract or identification number	166790
Number of Individuals Covered	193
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $31,985
Total amount of fees paid to insurance company	USD $1,856
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

627734

Policy instance

Insurance contract or identification number	627734
Number of Individuals Covered	238
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,229
Total amount of fees paid to insurance company	USD $5,147
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )

Policy contract number

1713254

Policy instance

Insurance contract or identification number	1713254
Number of Individuals Covered	390
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $83,468
Total amount of fees paid to insurance company	USD $3,253
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

166790

Policy instance

Insurance contract or identification number	166790
Number of Individuals Covered	158
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $24,499
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

627734

Policy instance

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

166790

Policy instance

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Company Name:	TELA BIO, INC.
Employer identification number (EIN):	455320061
NAIC Classification:	541700

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5141284