401k Plan data: DELTECH MONOMERS OPCO, LLC ERISA WRAP BENEFIT PLAN plan

DELTECH MONOMERS OPCO, LLC ERISA WRAP BENEFIT PLAN 401k Plan overview

Plan Name	DELTECH MONOMERS OPCO, LLC ERISA WRAP BENEFIT PLAN
Plan identification number	504

DELTECH MONOMERS OPCO, LLC ERISA WRAP BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

DELTECH MONOMERS OPCO LLC has sponsored the creation of one or more 401k plans.

Company Name: DELTECH MONOMERS OPCO LLC

Employer identification number (EIN): 871574877

NAIC Classification: 325900
NAIC Description: Other Chemical Product and Preparation Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DELTECH MONOMERS OPCO, LLC ERISA WRAP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2023-09-01 ADAM GERACE 2024-12-16
504 2022-09-01 ADAM GERACE 2024-01-23

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
504	2023-09-01	ADAM GERACE	2024-12-16
504	2022-09-01	ADAM GERACE	2024-01-23

Form 5500 Responses for DELTECH MONOMERS OPCO, LLC ERISA WRAP BENEFIT PLAN

2023: DELTECH MONOMERS OPCO, LLC ERISA WRAP BENEFIT PLAN 2023 form 5500 responses
2023-09-01	Type of plan entity	Single employer plan
2023-09-01	Plan funding arrangement – Insurance	Yes
2023-09-01	Plan benefit arrangement – Insurance	Yes
2022: DELTECH MONOMERS OPCO, LLC ERISA WRAP BENEFIT PLAN 2022 form 5500 responses
2022-09-01	Type of plan entity	Single employer plan
2022-09-01	First time form 5500 has been submitted	Yes
2022-09-01	Plan funding arrangement – Insurance	Yes
2022-09-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

78T20ERC

Policy instance

Insurance contract or identification number	78T20ERC
Number of Individuals Covered	107
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $0
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?	Yes

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

Policy contract number

E9401

Policy instance

Insurance contract or identification number	E9401
Number of Individuals Covered	17
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $1,530
Total amount of fees paid to insurance company	USD $11
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $9,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM0609922

Policy instance

Insurance contract or identification number	SGM0609922
Number of Individuals Covered	107
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $12,706
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $112,588
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136-007108

Policy instance

Insurance contract or identification number	136-007108
Number of Individuals Covered	235
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $9,480
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $103,975
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

AI110930

Policy instance

Insurance contract or identification number	AI110930
Number of Individuals Covered	107
Insurance policy start date	2023-09-01
Insurance policy end date	2024-08-31
Total amount of commissions paid to insurance broker	USD $3,163
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
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
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to Carrier	USD $17,047
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

78T20ERC

Policy instance

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM0609922

Policy instance

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

136009777

Policy instance

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Company Name:	DELTECH MONOMERS OPCO LLC
Employer identification number (EIN):	871574877
NAIC Classification:	325900
NAIC Description:	Other Chemical Product and Preparation Manufacturing