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SPECTRA PREMIUM MOBILITY SOLUTIONS WELFARE BENEFIT PLAN 401k Plan overview

Plan NameSPECTRA PREMIUM MOBILITY SOLUTIONS WELFARE BENEFIT PLAN
Plan identification number 502

SPECTRA PREMIUM MOBILITY SOLUTIONS WELFARE BENEFIT 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
  • Other welfare benefit cover

401k Sponsoring company profile

SPECTRA PREMIUM MOBILITY SOLUTIONS USA, LLC has sponsored the creation of one or more 401k plans.

Company Name:SPECTRA PREMIUM MOBILITY SOLUTIONS USA, LLC
Employer identification number (EIN):872541443
NAIC Classification:423100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SPECTRA PREMIUM MOBILITY SOLUTIONS WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-02-01KELSEY JONES2023-08-10
5022021-11-13KELSEY JONES2022-10-04

Plan Statistics for SPECTRA PREMIUM MOBILITY SOLUTIONS WELFARE BENEFIT PLAN

401k plan membership statisitcs for SPECTRA PREMIUM MOBILITY SOLUTIONS WELFARE BENEFIT PLAN

Measure Date Value
2022: SPECTRA PREMIUM MOBILITY SOLUTIONS WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-02-01121
Total number of active participants reported on line 7a of the Form 55002022-02-0198
Number of retired or separated participants receiving benefits2022-02-010
Number of other retired or separated participants entitled to future benefits2022-02-010
Total of all active and inactive participants2022-02-0198
2021: SPECTRA PREMIUM MOBILITY SOLUTIONS WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-13121
Total number of active participants reported on line 7a of the Form 55002021-11-13121
Number of retired or separated participants receiving benefits2021-11-130
Number of other retired or separated participants entitled to future benefits2021-11-130
Total of all active and inactive participants2021-11-13121

Form 5500 Responses for SPECTRA PREMIUM MOBILITY SOLUTIONS WELFARE BENEFIT PLAN

2022: SPECTRA PREMIUM MOBILITY SOLUTIONS WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Submission has been amendedNo
2022-02-01This submission is the final filingNo
2022-02-01This return/report is a short plan year return/report (less than 12 months)No
2022-02-01Plan is a collectively bargained planNo
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan funding arrangement – General assets of the sponsorYes
2022-02-01Plan benefit arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – General assets of the sponsorYes
2021: SPECTRA PREMIUM MOBILITY SOLUTIONS WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-11-13Type of plan entitySingle employer plan
2021-11-13First time form 5500 has been submittedYes
2021-11-13Submission has been amendedNo
2021-11-13This submission is the final filingNo
2021-11-13This return/report is a short plan year return/report (less than 12 months)Yes
2021-11-13Plan is a collectively bargained planNo
2021-11-13Plan funding arrangement – InsuranceYes
2021-11-13Plan funding arrangement – General assets of the sponsorYes
2021-11-13Plan benefit arrangement – InsuranceYes
2021-11-13Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract numberL04840
Policy instance 1
Insurance contract or identification numberL04840
Number of Individuals Covered209
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $31,580
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $859,676
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,133
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00564340
Policy instance 2
Insurance contract or identification number00564340
Number of Individuals Covered90
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $10,386
Total amount of fees paid to insurance companyUSD $4,080
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT DEATH AND DISMEMBERMENT, VOLUNTARY CRITICAL ILLNESS
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 CarrierUSD $92,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,386
Amount paid for insurance broker fees4080
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00564340
Policy instance 1
Insurance contract or identification number00564340
Number of Individuals Covered103
Insurance policy start date2021-11-14
Insurance policy end date2022-01-13
Total amount of commissions paid to insurance brokerUSD $2,598
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT DEATH AND DISMEMBERMENT, VOLUNTARY CRITICAL ILLNESS
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 CarrierUSD $23,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,598
Insurance broker organization code?3

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