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| Plan Name | ROM TECHNOLOGIES INC. VISION BENEFITS PLAN |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | ROM TECHNOLOGIES, INC. |
| Employer identification number (EIN): | 844142031 |
| NAIC Classification: | 339110 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2022-02-01 | ESTEFANIA LEON | 2023-07-21 |
| 2022: ROM TECHNOLOGIES INC. VISION BENEFITS PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-02-01 | Type of plan entity | Single employer plan |
| 2022-02-01 | First time form 5500 has been submitted | Yes |
| 2022-02-01 | This submission is the final filing | Yes |
| 2022-02-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2022-02-01 | Plan funding arrangement – Insurance | Yes |
| 2022-02-01 | Plan benefit arrangement – Insurance | Yes |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |||||||||||||||||||
| Policy contract number | 50007821001 | ||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||
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