| Plan Name | VISION PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | DENTAL DEPOT DSO, LLC |
| Employer identification number (EIN): | 204886566 |
| NAIC Classification: | 621210 |
| NAIC Description: | Offices of Dentists |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2020-01-01 | DAMON HAYES-MILLIGAN | 2021-08-19 | ||
| 502 | 2020-01-01 | DAMON HAYES-MILLIGAN | 2022-07-08 | ||
| 502 | 2019-01-01 | MARRIA LYNN BRYDON | 2020-03-30 |
| Measure | Date | Value |
|---|---|---|
| 2020: VISION PLAN 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 159 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 158 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 158 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: VISION PLAN 2019 401k membership | ||
| Total participants, beginning-of-year | 2019-01-01 | 201 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 159 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 159 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2020: VISION PLAN 2020 form 5500 responses | ||
|---|---|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | Yes |
| 2020-01-01 | This submission is the final filing | Yes |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: VISION PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | First time form 5500 has been submitted | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |
| Policy contract number | 99428551001 |
| Policy instance | 1 |