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OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameOSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN
Plan identification number 501

OSSIP OPTOMETRY P.C. WELFARE BENEFIT 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
  • Other welfare benefit cover

401k Sponsoring company profile

OSSIP OPTOMETRY P.C. has sponsored the creation of one or more 401k plans.

Company Name:OSSIP OPTOMETRY P.C.
Employer identification number (EIN):351788258
NAIC Classification:621320
NAIC Description:Offices of Optometrists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-06-01RYAN DABELOW RYAN DABELOW2018-02-23
5012015-06-01RYAN DABELOW RYAN DABELOW2016-12-29
5012014-06-01RYAN DABELOW RYAN DABELOW2016-01-08
5012013-06-01RYAN DABELOW RYAN DABELOW2016-01-08
5012012-06-01RYAN DABELOW RYAN DABELOW2016-01-08

Plan Statistics for OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN

401k plan membership statisitcs for OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN

Measure Date Value
2016: OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01389
Total number of active participants reported on line 7a of the Form 55002016-06-01297
Number of retired or separated participants receiving benefits2016-06-011
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-01298
2015: OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01395
Total number of active participants reported on line 7a of the Form 55002015-06-01389
Number of retired or separated participants receiving benefits2015-06-010
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-01389
2014: OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01491
Total number of active participants reported on line 7a of the Form 55002014-06-01395
Number of retired or separated participants receiving benefits2014-06-010
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-01395
2013: OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01338
Total number of active participants reported on line 7a of the Form 55002013-06-01419
Number of retired or separated participants receiving benefits2013-06-010
Number of other retired or separated participants entitled to future benefits2013-06-010
Total of all active and inactive participants2013-06-01419
2012: OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01122
Total number of active participants reported on line 7a of the Form 55002012-06-01338
Number of retired or separated participants receiving benefits2012-06-010
Number of other retired or separated participants entitled to future benefits2012-06-010
Total of all active and inactive participants2012-06-01338

Form 5500 Responses for OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN

2016: OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planNo
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – General assets of the sponsorYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – General assets of the sponsorYes
2015: OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingNo
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planNo
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – General assets of the sponsorYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – General assets of the sponsorYes
2014: OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Submission has been amendedNo
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planNo
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan funding arrangement – General assets of the sponsorYes
2014-06-01Plan benefit arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – General assets of the sponsorYes
2013: OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Submission has been amendedNo
2013-06-01This submission is the final filingNo
2013-06-01This return/report is a short plan year return/report (less than 12 months)No
2013-06-01Plan is a collectively bargained planNo
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan funding arrangement – General assets of the sponsorYes
2013-06-01Plan benefit arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – General assets of the sponsorYes
2012: OSSIP OPTOMETRY P.C. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01First time form 5500 has been submittedYes
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingNo
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planNo
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan funding arrangement – General assets of the sponsorYes
2012-06-01Plan benefit arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00084335
Policy instance 4
Insurance contract or identification number00084335
Number of Individuals Covered330
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $64,651
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,710,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,651
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberY3183
Policy instance 3
Insurance contract or identification numberY3183
Number of Individuals Covered63
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $4,812
Total amount of fees paid to insurance companyUSD $205
Other welfare benefits providedWORKSITE BENEFITS
Welfare Benefit Premiums Paid to CarrierUSD $46,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $780
Insurance broker organization code?3
Amount paid for insurance broker fees92
Additional information about fees paid to insurance brokerTOTAL FEES PAID
Insurance broker nameCRYSTAL DAWN COLE
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00084335A
Policy instance 2
Insurance contract or identification number00084335A
Number of Individuals Covered389
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $6,743
Total amount of fees paid to insurance companyUSD $1,019
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,743
Amount paid for insurance broker fees1019
Additional information about fees paid to insurance brokerTOTAL FEES PAID
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number946559
Policy instance 1
Insurance contract or identification number946559
Number of Individuals Covered201
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10,486
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $104,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,486
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00084335
Policy instance 3
Insurance contract or identification number00084335
Number of Individuals Covered308
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $58,115
Total amount of fees paid to insurance companyUSD $126
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,644,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $58,115
Amount paid for insurance broker fees126
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00084335A
Policy instance 2
Insurance contract or identification number00084335A
Number of Individuals Covered395
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $7,292
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $53,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,292
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number946559
Policy instance 1
Insurance contract or identification number946559
Number of Individuals Covered179
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $9,453
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $94,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,453
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number946559
Policy instance 3
Insurance contract or identification number946559
Number of Individuals Covered151
Insurance policy start date2013-06-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,862
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $48,620
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,862
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00084335
Policy instance 1
Insurance contract or identification number00084335
Number of Individuals Covered248
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $45,731
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,354,372
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,731
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00084335A
Policy instance 2
Insurance contract or identification number00084335A
Number of Individuals Covered419
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $5,692
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,692
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number00084335
Policy instance 5
Insurance contract or identification number00084335
Number of Individuals Covered191
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $34,121
Total amount of fees paid to insurance companyUSD $1,674
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,107,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,121
Amount paid for insurance broker fees1674
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1030572
Policy instance 4
Insurance contract or identification number1030572
Number of Individuals Covered338
Insurance policy start date2012-10-01
Insurance policy end date2013-05-31
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $763
Amount paid for insurance broker fees173
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00084335
Policy instance 3
Insurance contract or identification number00084335
Number of Individuals Covered0
Insurance policy start date2012-06-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $124
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $124
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number5452587
Policy instance 1
Insurance contract or identification number5452587
Number of Individuals Covered47
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $1,267
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedVOLUNTARY ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $8,447
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,267
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
Policy contract number603274
Policy instance 2
Insurance contract or identification number603274
Number of Individuals Covered93
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $4,918
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,108
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,918
Insurance broker organization code?3
Insurance broker nameERTEL & COMPANY INC.

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