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VISION, DENTAL, GROUP LIFE AND AD&D PLAN 401k Plan overview

Plan NameVISION, DENTAL, GROUP LIFE AND AD&D PLAN
Plan identification number 502

VISION, DENTAL, GROUP LIFE AND AD&D PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

EMPIRE OFFICE, INC. has sponsored the creation of one or more 401k plans.

Company Name:EMPIRE OFFICE, INC.
Employer identification number (EIN):131945763
NAIC Classification:337000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VISION, DENTAL, GROUP LIFE AND AD&D PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022023-04-01
5022023-04-01YOLANDA BURGOS
5022022-04-01
5022022-04-01YOLANDA BURGOS
5022021-04-01
5022021-04-01YOLANDA BURGOS
5022020-04-01
5022017-04-01YOLANDA L BURGOS
5022016-04-01YOLANDA BURGOS
5022015-04-01YOLANDA BURGOS

Plan Statistics for VISION, DENTAL, GROUP LIFE AND AD&D PLAN

401k plan membership statisitcs for VISION, DENTAL, GROUP LIFE AND AD&D PLAN

Measure Date Value
2023: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2023 401k membership
Total participants, beginning-of-year2023-04-01267
Total number of active participants reported on line 7a of the Form 55002023-04-01239
Number of retired or separated participants receiving benefits2023-04-010
Number of other retired or separated participants entitled to future benefits2023-04-019
Total of all active and inactive participants2023-04-01248
2022: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2022 401k membership
Total participants, beginning-of-year2022-04-01235
Total number of active participants reported on line 7a of the Form 55002022-04-01246
Number of retired or separated participants receiving benefits2022-04-012
Number of other retired or separated participants entitled to future benefits2022-04-0124
Total of all active and inactive participants2022-04-01272
2021: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2021 401k membership
Total participants, beginning-of-year2021-04-01263
Total number of active participants reported on line 7a of the Form 55002021-04-01352
Number of retired or separated participants receiving benefits2021-04-013
Number of other retired or separated participants entitled to future benefits2021-04-0117
Total of all active and inactive participants2021-04-01372
2020: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2020 401k membership
Total participants, beginning-of-year2020-04-01284
Total number of active participants reported on line 7a of the Form 55002020-04-01239
Number of retired or separated participants receiving benefits2020-04-015
Number of other retired or separated participants entitled to future benefits2020-04-017
Total of all active and inactive participants2020-04-01251
2017: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2017 401k membership
Total participants, beginning-of-year2017-04-01161
Total number of active participants reported on line 7a of the Form 55002017-04-01177
Number of retired or separated participants receiving benefits2017-04-010
Number of other retired or separated participants entitled to future benefits2017-04-010
Total of all active and inactive participants2017-04-01177
2016: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2016 401k membership
Total participants, beginning-of-year2016-04-01137
Total number of active participants reported on line 7a of the Form 55002016-04-01160
Number of retired or separated participants receiving benefits2016-04-011
Number of other retired or separated participants entitled to future benefits2016-04-010
Total of all active and inactive participants2016-04-01161
2015: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01136
Total number of active participants reported on line 7a of the Form 55002015-04-01137
Number of retired or separated participants receiving benefits2015-04-010
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-01137

Form 5500 Responses for VISION, DENTAL, GROUP LIFE AND AD&D PLAN

2023: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2023 form 5500 responses
2023-04-01Type of plan entitySingle employer plan
2023-04-01Submission has been amendedNo
2023-04-01This submission is the final filingNo
2023-04-01This return/report is a short plan year return/report (less than 12 months)No
2023-04-01Plan is a collectively bargained planNo
2023-04-01Plan funding arrangement – InsuranceYes
2023-04-01Plan benefit arrangement – InsuranceYes
2022: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingNo
2022-04-01This return/report is a short plan year return/report (less than 12 months)No
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – InsuranceYes
2021: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – InsuranceYes
2021-04-01Plan benefit arrangement – InsuranceYes
2020: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Submission has been amendedNo
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)No
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – InsuranceYes
2020-04-01Plan benefit arrangement – InsuranceYes
2017: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – InsuranceYes
2017-04-01Plan benefit arrangement – InsuranceYes
2016: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan benefit arrangement – InsuranceYes
2015: VISION, DENTAL, GROUP LIFE AND AD&D PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01First time form 5500 has been submittedYes
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION (National Association of Insurance Commissioners NAIC id number: 52009 )
Policy contract number5998790
Policy instance 3
Insurance contract or identification number5998790
Number of Individuals Covered45
Insurance policy start date2023-04-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $461
Total amount of fees paid to insurance companyUSD $58
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 BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
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 $4,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5998790
Policy instance 2
Insurance contract or identification number5998790
Number of Individuals Covered146
Insurance policy start date2023-04-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $2,656
Total amount of fees paid to insurance companyUSD $435
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 BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $32,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number239440
Policy instance 1
Insurance contract or identification number239440
Number of Individuals Covered254
Insurance policy start date2023-04-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $4,072
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $199,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION (National Association of Insurance Commissioners NAIC id number: 52009 )
Policy contract number5998790
Policy instance 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5998790
Policy instance 2
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number239440
Policy instance 1
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98736211001
Policy instance 4
SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION (National Association of Insurance Commissioners NAIC id number: 52009 )
Policy contract number5998790
Policy instance 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5998790
Policy instance 2
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number239440
Policy instance 1
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number98736211001
Policy instance 4
SAFEGUARD HEALTH PLANS, INC., A FLORIDA CORPORATION (National Association of Insurance Commissioners NAIC id number: 52009 )
Policy contract number5998790
Policy instance 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5998790
Policy instance 2
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number239440
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number239440
Policy instance 1
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number239440
Policy instance 1

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