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| Plan Name | VISION FIRST EYE CARE GROUP HEALTH BENEFIT PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | PINNACLE EYE CARE, INC. D/B/A VISION FIRST |
| Employer identification number (EIN): | 752993005 |
| NAIC Classification: | 446130 |
| NAIC Description: | Optical Goods Stores |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2023-01-01 | DEREK RADCLIFFE | 2024-05-15 | ||
| 501 | 2022-01-01 | DEREK RADCLIFFE | 2023-07-10 | ||
| 501 | 2021-01-01 | DEREK RADCLIFFE | 2022-08-22 |
| Measure | Date | Value |
|---|---|---|
| 2023: VISION FIRST EYE CARE GROUP HEALTH BENEFIT PLAN 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-01-01 | 95 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 100 |
| Total of all active and inactive participants | 2023-01-01 | 100 |
| 2022: VISION FIRST EYE CARE GROUP HEALTH BENEFIT PLAN 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-01-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 95 |
| Total of all active and inactive participants | 2022-01-01 | 95 |
| 2021: VISION FIRST EYE CARE GROUP HEALTH BENEFIT PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 109 |
| Total of all active and inactive participants | 2021-01-01 | 109 |
| 2023: VISION FIRST EYE CARE GROUP HEALTH BENEFIT PLAN 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: VISION FIRST EYE CARE GROUP HEALTH BENEFIT PLAN 2022 form 5500 responses | ||
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: VISION FIRST EYE CARE GROUP HEALTH BENEFIT PLAN 2021 form 5500 responses | ||
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | First time form 5500 has been submitted | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) | |||||||||||||||||
| Policy contract number | L06941 | ||||||||||||||||
| Policy instance | 1 | ||||||||||||||||
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| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) | |||||||||||||||||
| Policy contract number | 717738 | ||||||||||||||||
| Policy instance | 1 | ||||||||||||||||
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| HUMANA HEALTH PLAN, INC. (National Association of Insurance Commissioners NAIC id number: 95885 ) | |||||||||||||||||
| Policy contract number | 717738 | ||||||||||||||||
| Policy instance | 1 | ||||||||||||||||
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