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GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 401k Plan overview

Plan NameGRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN
Plan identification number 501

GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

BLUE SKY VISION EYE CARE, P.C. has sponsored the creation of one or more 401k plans.

Company Name:BLUE SKY VISION EYE CARE, P.C.
Employer identification number (EIN):382394920
NAIC Classification:446130
NAIC Description:Optical Goods Stores

Additional information about BLUE SKY VISION EYE CARE, P.C.

Jurisdiction of Incorporation: Michigan Department of Licensing & Regulatory Affairs
Incorporation Date:
Company Identification Number: 262155

More information about BLUE SKY VISION EYE CARE, P.C.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01ANN BUSCAVAGE2023-12-18
5012021-01-01JOE SCHUSTER2022-10-14
5012021-01-01ANN BUSCAVAGE2023-10-26
5012017-01-01MELISSA DABROWSKI MELISSA DABROWSKI2018-07-30
5012017-01-01
5012016-01-01KAREN CODA
5012015-01-01KAREN CODA
5012014-01-01ROBERT WOLFORD ROBERT WOLFORD2015-07-15
5012013-01-01KAREN CODA
5012012-01-01KAREN CODA
5012011-01-01ROBERT WOLFORD
5012010-01-01ROBERT WOLFORD ROBERT WOLFORD2011-07-29
5012009-01-01ROBERT WOLFORD ROBERT WOLFORD2010-07-30

Plan Statistics for GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN

401k plan membership statisitcs for GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN

Measure Date Value
2022: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01784
Total number of active participants reported on line 7a of the Form 55002022-01-01784
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01784
Number of employers contributing to the scheme2022-01-010
2021: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01175
Total number of active participants reported on line 7a of the Form 55002021-01-01175
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01175
Number of employers contributing to the scheme2021-01-010
2017: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01421
Total number of active participants reported on line 7a of the Form 55002017-01-01425
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01425
2016: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01226
Total number of active participants reported on line 7a of the Form 55002016-01-01421
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01421
2015: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01224
Total number of active participants reported on line 7a of the Form 55002015-01-01226
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01226
2014: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01202
Total number of active participants reported on line 7a of the Form 55002014-01-01224
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01224
2013: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01401
Total number of active participants reported on line 7a of the Form 55002013-01-01397
Number of retired or separated participants receiving benefits2013-01-012
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01399
2012: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01401
Total number of active participants reported on line 7a of the Form 55002012-01-01401
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01401
2011: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01363
Total number of active participants reported on line 7a of the Form 55002011-01-01401
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01401
2010: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01352
Total number of active participants reported on line 7a of the Form 55002010-01-01363
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01363
2009: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01322
Total number of active participants reported on line 7a of the Form 55002009-01-01352
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01352

Form 5500 Responses for GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN

2022: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01Submission has been amendedYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2017: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: GRAND RAPIDS OPHTHALMOLOGY, PC EMPLOYEE DENTAL PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number790712
Policy instance 1
Insurance contract or identification number790712
Number of Individuals Covered784
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number790712
Policy instance 1
Insurance contract or identification number790712
Number of Individuals Covered762
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $110,321
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,677,359
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $110,321
Amount paid for insurance broker fees0
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10247428
Policy instance 1
Insurance contract or identification number10247428
Number of Individuals Covered175
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10247430
Policy instance 2
Insurance contract or identification number10247430
Number of Individuals Covered175
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number40000100024
Policy instance 3
Insurance contract or identification number40000100024
Number of Individuals Covered175
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 number3790
Policy instance 4
Insurance contract or identification number3790
Number of Individuals Covered175
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
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 number790712
Policy instance 5
Insurance contract or identification number790712
Number of Individuals Covered175
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number24954
Policy instance 6
Insurance contract or identification number24954
Number of Individuals Covered175
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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