401k Plan data: SPECTRUM DIVERSIFIED DESIGN, INC. HEALTH AND WELFARE PLAN plan

SPECTRUM DIVERSIFIED DESIGN, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan Name	SPECTRUM DIVERSIFIED DESIGN, INC. HEALTH AND WELFARE PLAN
Plan identification number	501

SPECTRUM DIVERSIFIED DESIGN, INC. HEALTH AND WELFARE 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 Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

SPECTRUM DIVERSIFIED DESIGNS, LLC has sponsored the creation of one or more 401k plans.

Company Name: SPECTRUM DIVERSIFIED DESIGNS, LLC

Employer identification number (EIN): 475369151

NAIC Classification: 423200

Additional information about SPECTRUM DIVERSIFIED DESIGNS, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 5826730

More information about SPECTRUM DIVERSIFIED DESIGNS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SPECTRUM DIVERSIFIED DESIGN, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 LARRY ROKAS 2023-09-18
501 2021-01-01 LARRY ROKAS 2022-06-28

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01	LARRY ROKAS	2023-09-18
501	2021-01-01	LARRY ROKAS	2022-06-28

Form 5500 Responses for SPECTRUM DIVERSIFIED DESIGN, INC. HEALTH AND WELFARE PLAN

2022: SPECTRUM DIVERSIFIED DESIGN, INC. HEALTH AND WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: SPECTRUM DIVERSIFIED DESIGN, INC. HEALTH AND WELFARE 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	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

2Y7241

Policy instance

Insurance contract or identification number	2Y7241
Number of Individuals Covered	48
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $18,684
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $467,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

51171

Policy instance

Insurance contract or identification number	51171
Number of Individuals Covered	25
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $9,716
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $27,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BT6M

Policy instance

Insurance contract or identification number	GVTL0BT6M
Number of Individuals Covered	51
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,730
Total amount of fees paid to insurance company	USD $3,625
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $65,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

2Y7241

Policy instance

AMERICAN HERITAGE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60534 )

Policy contract number

51171

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0BT6M

Policy instance

Potentially related plans

SPECTRUM DIVERSIFIED DESIGNS INC. 401(K) RETIREMENT PLAN [EIN = 341492323]

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Company Name:	SPECTRUM DIVERSIFIED DESIGNS, LLC
Employer identification number (EIN):	475369151
NAIC Classification:	423200

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	5826730