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PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN 401k Plan overview

Plan NamePRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN
Plan identification number 501

PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN Benefits

401k Plan TypeWelfare 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)

401k Sponsoring company profile

PRISM SPECTRUM HOLDINGS, LLC has sponsored the creation of one or more 401k plans.

Company Name:PRISM SPECTRUM HOLDINGS, LLC
Employer identification number (EIN):811000401
NAIC Classification:238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-10-01DULCIA MAIRE2023-10-10
5012021-10-01DULCIA MAIRE2023-04-24
5012020-10-01ROSS WACHOWSKI2022-04-20
5012019-10-01ROSS WACHOWSKI2021-03-19
5012018-10-01DAVID ROSS WACHOWSKI2020-06-10

Plan Statistics for PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN

401k plan membership statisitcs for PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN

Measure Date Value
2022: PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-10-01406
Total number of active participants reported on line 7a of the Form 55002022-10-01248
Number of retired or separated participants receiving benefits2022-10-017
Number of other retired or separated participants entitled to future benefits2022-10-010
Total of all active and inactive participants2022-10-01255
Number of employers contributing to the scheme2022-10-010
2021: PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01298
Total number of active participants reported on line 7a of the Form 55002021-10-01408
Number of retired or separated participants receiving benefits2021-10-010
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-01408
Number of employers contributing to the scheme2021-10-010
2020: PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01252
Total number of active participants reported on line 7a of the Form 55002020-10-010
Number of retired or separated participants receiving benefits2020-10-010
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-010
Number of employers contributing to the scheme2020-10-010
2019: PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01247
Total number of active participants reported on line 7a of the Form 55002019-10-01246
Number of retired or separated participants receiving benefits2019-10-013
Number of other retired or separated participants entitled to future benefits2019-10-013
Total of all active and inactive participants2019-10-01252
Number of employers contributing to the scheme2019-10-010
2018: PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01100
Total number of active participants reported on line 7a of the Form 55002018-10-01129
Number of retired or separated participants receiving benefits2018-10-010
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01129
Number of employers contributing to the scheme2018-10-010

Form 5500 Responses for PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN

2022: PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-10-01Type of plan entitySingle employer plan
2022-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-10-01Plan funding arrangement – InsuranceYes
2022-10-01Plan funding arrangement – General assets of the sponsorYes
2022-10-01Plan benefit arrangement – InsuranceYes
2022-10-01Plan benefit arrangement – General assets of the sponsorYes
2021: PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan funding arrangement – General assets of the sponsorYes
2021-10-01Plan benefit arrangement – InsuranceYes
2021-10-01Plan benefit arrangement – General assets of the sponsorYes
2020: PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01This submission is the final filingYes
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan benefit arrangement – InsuranceYes
2019: PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan benefit arrangement – InsuranceYes
2018: PRISM SPECTRUM HOLDINGS LLC HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01First time form 5500 has been submittedYes
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5965385
Policy instance 1
Insurance contract or identification number5965385
Number of Individuals Covered606
Insurance policy start date2022-10-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,571
Total amount of fees paid to insurance companyUSD $214
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,571
Amount paid for insurance broker fees214
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number106664-SHORT
Policy instance 2
Insurance contract or identification number106664-SHORT
Number of Individuals Covered526
Insurance policy start date2022-10-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $908
Total amount of fees paid to insurance companyUSD $25,393
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $958,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $908
Amount paid for insurance broker fees25393
Additional information about fees paid to insurance brokerDIRECT COMPENSATION, INDIRECT COMPENSATION
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number888671G
Policy instance 3
Insurance contract or identification number888671G
Number of Individuals Covered248
Insurance policy start date2022-10-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05965385
Policy instance 1
Insurance contract or identification numberTM05965385
Number of Individuals Covered631
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $10,245
Total amount of fees paid to insurance companyUSD $1,424
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,245
Amount paid for insurance broker fees1424
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION, NON-MONETARY COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number106664
Policy instance 2
Insurance contract or identification number106664
Number of Individuals Covered503
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $3,555
Total amount of fees paid to insurance companyUSD $101,620
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,761,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,959
Amount paid for insurance broker fees55724
Additional information about fees paid to insurance brokerDIRECT COMPENSATION, INDIRECT COMPENSATION
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number888671G
Policy instance 3
Insurance contract or identification number888671G
Number of Individuals Covered421
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $62,079
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, ACCIDENT, CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $310,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $57,801
Amount paid for insurance broker fees0
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number106664
Policy instance 1
Insurance contract or identification number106664
Number of Individuals Covered427
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $3,290
Total amount of fees paid to insurance companyUSD $86,276
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,861,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,290
Amount paid for insurance broker fees86276
Additional information about fees paid to insurance brokerDIRECT COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number106664
Policy instance 1
Insurance contract or identification number106664
Number of Individuals Covered463
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $3,477
Total amount of fees paid to insurance companyUSD $79,896
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,649,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $2,365
Amount paid for insurance broker fees61915
Additional information about fees paid to insurance broker2019 PPP SPECIALTY NEW BUSINESS RISK DIRECT COMPENSATION
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number106664
Policy instance 1
Insurance contract or identification number106664
Number of Individuals Covered302
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $54,602
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,813,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees54602
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3

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