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GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY PLAN 401k Plan overview

Plan NameGRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY PLAN
Plan identification number 504

GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Long-term disability cover
  • 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.

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 LONG TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042017-01-01MELISSA DABROWSKI MELISSA DABROWSKI2018-07-30
5042017-01-01
5042016-01-01KAREN CODA
5042015-01-01KAREN CODA
5042014-01-01ROBERT WOLFORD ROBERT WOLFORD2015-07-15
5042013-01-01KAREN CODA

Plan Statistics for GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY PLAN

401k plan membership statisitcs for GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY PLAN

Measure Date Value
2017: GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01219
Total number of active participants reported on line 7a of the Form 55002017-01-01234
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 participants2017-01-01234
2016: GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01204
Total number of active participants reported on line 7a of the Form 55002016-01-01219
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 participants2016-01-01219
2015: GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01196
Total number of active participants reported on line 7a of the Form 55002015-01-01204
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 participants2015-01-01204
2014: GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01197
Total number of active participants reported on line 7a of the Form 55002014-01-01196
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 participants2014-01-01196
2013: GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01314
Total number of active participants reported on line 7a of the Form 55002013-01-01197
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01197

Form 5500 Responses for GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY PLAN

2017: GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY 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 – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY 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 – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY 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 – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY 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 – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: GRAND RAPIDS OPHTHALMOLOGY PC EMPLOYEE LONG TERM DISABILITY 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 – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number1009043200000
Policy instance 1
Insurance contract or identification number1009043200000
Number of Individuals Covered234
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $11,537
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $76,913
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,537
Insurance broker organization code?3
Insurance broker namePHILIP J PETERSON
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number1009043200000
Policy instance 1
Insurance contract or identification number1009043200000
Number of Individuals Covered204
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10,876
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $72,505
Commission paid to Insurance BrokerUSD $10,876
Insurance broker organization code?3
Insurance broker namePHILIP J PETERSON
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number1009043200000
Policy instance 1
Insurance contract or identification number1009043200000
Number of Individuals Covered196
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $10,699
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $71,329
Commission paid to Insurance BrokerUSD $10,699
Insurance broker organization code?3
Insurance broker namePHILIP J PETERSON
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number1009043200000
Policy instance 1
Insurance contract or identification number1009043200000
Number of Individuals Covered197
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $10,347
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $68,981
Commission paid to Insurance BrokerUSD $10,347
Insurance broker organization code?3
Insurance broker namePHILIP J PETERSON

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