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| Plan Name | GROUP LIFE & AD&D |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | 20/20 VISION CENTER, LLC |
| Employer identification number (EIN): | 800873981 |
| 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 | 2023-07-01 | LAURA MORENO | 2024-12-16 | ||
| 501 | 2022-07-01 | LAURA MORENO | 2023-12-05 |
| Measure | Date | Value |
|---|---|---|
| 2023: GROUP LIFE & AD&D 2023 401k membership | ||
| Total participants, beginning-of-year | 2023-07-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-07-01 | 107 |
| Number of retired or separated participants receiving benefits | 2023-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-07-01 | 0 |
| Total of all active and inactive participants | 2023-07-01 | 107 |
| Number of employers contributing to the scheme | 2023-07-01 | 0 |
| 2022: GROUP LIFE & AD&D 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-07-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 120 |
| Number of retired or separated participants receiving benefits | 2022-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-07-01 | 0 |
| Total of all active and inactive participants | 2022-07-01 | 120 |
| Number of employers contributing to the scheme | 2022-07-01 | 0 |
| 2023: GROUP LIFE & AD&D 2023 form 5500 responses | ||
|---|---|---|
| 2023-07-01 | Type of plan entity | Single employer plan |
| 2023-07-01 | Plan funding arrangement – Insurance | Yes |
| 2023-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2022: GROUP LIFE & AD&D 2022 form 5500 responses | ||
| 2022-07-01 | Type of plan entity | Single employer plan |
| 2022-07-01 | First time form 5500 has been submitted | Yes |
| 2022-07-01 | Plan funding arrangement – Insurance | Yes |
| 2022-07-01 | Plan benefit arrangement – Insurance | Yes |
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) | |||||||||||||||||||||
| Policy contract number | 370258 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |||||||||||||||||||||
| Policy contract number | 370258 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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