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| Plan Name | DESIGN TEAMS, INC. SELF FUNDED HEALTH PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | DESIGN TEAMS, INC. |
| Employer identification number (EIN): | 521329554 |
| NAIC Classification: | 561490 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2017-01-01 | KIM GOMOLJAK | KIM GOMOLJAK | 2018-05-24 | |
| 502 | 2016-01-01 | KIM GOMOLJAK | KIM GOMOLJAK | 2017-07-18 |
| Measure | Date | Value |
|---|---|---|
| 2017: DESIGN TEAMS, INC. SELF FUNDED HEALTH PLAN 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 36 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 27 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 6 |
| Total of all active and inactive participants | 2017-01-01 | 33 |
| Total participants | 2017-01-01 | 33 |
| 2016: DESIGN TEAMS, INC. SELF FUNDED HEALTH PLAN 2016 401k membership | ||
| Total participants, beginning-of-year | 2016-01-01 | 38 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 31 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 5 |
| Total of all active and inactive participants | 2016-01-01 | 36 |
| Total participants | 2016-01-01 | 36 |
| 2017: DESIGN TEAMS, INC. SELF FUNDED HEALTH PLAN 2017 form 5500 responses | ||
|---|---|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: DESIGN TEAMS, INC. SELF FUNDED HEALTH PLAN 2016 form 5500 responses | ||
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| CIGNA PPO C/O CWI BENEFITS, INC. (National Association of Insurance Commissioners NAIC id number: 0000 ) | |
| Policy contract number | |
| Policy instance | 1 |
| GROUP BENEFIT SERVICES (National Association of Insurance Commissioners NAIC id number: 52429 ) | |
| Policy contract number | 490 |
| Policy instance | 2 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | |
| Policy instance | 3 |
| DOMINIONNATIONAL DENTAL (National Association of Insurance Commissioners NAIC id number: 95657 ) | |
| Policy contract number | |
| Policy instance | 4 |
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