401k Plan data: DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN plan

DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN 401k Plan overview

Plan Name	DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN
Plan identification number	502

DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

DIVERSIFIED MANAGEMENT COMPANY, LLC has sponsored the creation of one or more 401k plans.

Company Name: DIVERSIFIED MANAGEMENT COMPANY, LLC

Employer identification number (EIN): 871435178

NAIC Classification: 339110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2022-01-01
502 2021-01-01 PATRICK LAWTON 2022-08-03

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2022-01-01
502	2021-01-01	PATRICK LAWTON	2022-08-03

Plan Statistics for DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN

401k plan membership statisitcs for DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN

Measure Date Value
2022: DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 138
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 39
Total of all active and inactive participants 2022-01-01 178
2021: DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 120
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 120
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 2021-01-01 120
Number of employers contributing to the scheme 2021-01-01 0

Measure	Date	Value
2022: DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	138
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	39
Total of all active and inactive participants	2022-01-01	178
2021: DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	120
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	120
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	120
Number of employers contributing to the scheme	2021-01-01	0

Form 5500 Responses for DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL PLAN

2022: DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL 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: DIVERSIFIED MANAGEMENT COMPANY, LLC MEDICAL 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 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

00635508

Policy instance

Insurance contract or identification number	00635508
Number of Individuals Covered	138
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $51,648
Total amount of fees paid to insurance company	USD $24,318
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	Yes
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
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 $357,696
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $51,648
Insurance broker organization code?	3
Amount paid for insurance broker fees	24318
Additional information about fees paid to insurance broker	SERVICE AND/OR GENERAL AGENT FEE

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

66-17018

Policy instance

Insurance contract or identification number	66-17018
Number of Individuals Covered	113
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $40,875
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,250
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

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Company Name:	DIVERSIFIED MANAGEMENT COMPANY, LLC
Employer identification number (EIN):	871435178
NAIC Classification:	339110