401k Plan data: LACROIX OPTICAL COMPANY HEALTH plan

LACROIX OPTICAL COMPANY HEALTH 401k Plan overview

Plan Name	LACROIX OPTICAL COMPANY HEALTH
Plan identification number	502

LACROIX OPTICAL COMPANY HEALTH Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Other welfare benefit cover

401k Sponsoring company profile

LACROIX PRECISION OPTICS, INC. has sponsored the creation of one or more 401k plans.

Company Name: LACROIX PRECISION OPTICS, INC.

Employer identification number (EIN): 362085033

NAIC Classification: 339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LACROIX OPTICAL COMPANY HEALTH

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2023-10-01 KIRKLAND J WARDEN 2025-01-22 KIRKLAND J WARDEN 2025-01-22
502 2022-10-01 KIRKLAND J WARDEN 2024-04-26 KIRKLAND J WARDEN 2024-04-26
502 2022-04-01 KIRKLAND J WARDEN 2023-05-16 KIRKLAND J WARDEN 2023-05-16
502 2021-04-01 KIRKLAND J WARDEN 2022-10-03 KIRKLAND J WARDEN 2022-10-03
502 2020-04-01 KIRKLAND J WARDEN 2021-07-27 KIRKLAND J WARDEN 2021-07-27
502 2019-04-01 KIRKLAND J WARDEN 2020-10-30 KIRKLAND J WARDEN 2020-10-30
502 2018-04-01 RAYMOND LACROIX 2019-10-25 RAYMOND LACROIX 2019-10-25
502 2017-04-01
502 2016-04-01
502 2015-06-01
502 2015-06-01
502 2015-06-01
502 2014-06-01
502 2014-06-01
502 2013-06-01
502 2012-06-01 RAYMOND LACROIX
502 2011-06-01 RAYMOND LACROIX
502 2010-06-01 RAYMOND LACROIX
502 2009-06-01 RAYMOND LACROIX

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2023-10-01	KIRKLAND J WARDEN	2025-01-22	KIRKLAND J WARDEN	2025-01-22
502	2022-10-01	KIRKLAND J WARDEN	2024-04-26	KIRKLAND J WARDEN	2024-04-26
502	2022-04-01	KIRKLAND J WARDEN	2023-05-16	KIRKLAND J WARDEN	2023-05-16
502	2021-04-01	KIRKLAND J WARDEN	2022-10-03	KIRKLAND J WARDEN	2022-10-03
502	2020-04-01	KIRKLAND J WARDEN	2021-07-27	KIRKLAND J WARDEN	2021-07-27
502	2019-04-01	KIRKLAND J WARDEN	2020-10-30	KIRKLAND J WARDEN	2020-10-30
502	2018-04-01	RAYMOND LACROIX	2019-10-25	RAYMOND LACROIX	2019-10-25
502	2017-04-01
502	2016-04-01
502	2015-06-01
502	2015-06-01
502	2015-06-01
502	2014-06-01
502	2014-06-01
502	2013-06-01
502	2012-06-01	RAYMOND LACROIX
502	2011-06-01	RAYMOND LACROIX
502	2010-06-01	RAYMOND LACROIX
502	2009-06-01	RAYMOND LACROIX

Form 5500 Responses for LACROIX OPTICAL COMPANY HEALTH

2023: LACROIX OPTICAL COMPANY HEALTH 2023 form 5500 responses
2023-10-01	Type of plan entity	Single employer plan
2023-10-01	Plan funding arrangement – Insurance	Yes
2023-10-01	Plan benefit arrangement – Insurance	Yes
2022: LACROIX OPTICAL COMPANY HEALTH 2022 form 5500 responses
2022-10-01	Type of plan entity	Single employer plan
2022-10-01	Plan funding arrangement – Insurance	Yes
2022-10-01	Plan benefit arrangement – Insurance	Yes
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes
2021: LACROIX OPTICAL COMPANY HEALTH 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2020: LACROIX OPTICAL COMPANY HEALTH 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2019: LACROIX OPTICAL COMPANY HEALTH 2019 form 5500 responses
2019-04-01	Type of plan entity	Single employer plan
2019-04-01	Plan funding arrangement – Insurance	Yes
2019-04-01	Plan benefit arrangement – Insurance	Yes
2018: LACROIX OPTICAL COMPANY HEALTH 2018 form 5500 responses
2018-04-01	Type of plan entity	Single employer plan
2018-04-01	Plan funding arrangement – Insurance	Yes
2018-04-01	Plan benefit arrangement – Insurance	Yes
2017: LACROIX OPTICAL COMPANY HEALTH 2017 form 5500 responses
2017-04-01	Type of plan entity	Single employer plan
2017-04-01	Plan funding arrangement – Insurance	Yes
2017-04-01	Plan benefit arrangement – Insurance	Yes
2016: LACROIX OPTICAL COMPANY HEALTH 2016 form 5500 responses
2016-04-01	Type of plan entity	Single employer plan
2016-04-01	Plan funding arrangement – Insurance	Yes
2016-04-01	Plan benefit arrangement – Insurance	Yes
2015: LACROIX OPTICAL COMPANY HEALTH 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	This submission is the final filing	Yes
2015-06-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-06-01	Plan funding arrangement – Insurance	Yes
2015-06-01	Plan benefit arrangement – Insurance	Yes
2014: LACROIX OPTICAL COMPANY HEALTH 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2013: LACROIX OPTICAL COMPANY HEALTH 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2012: LACROIX OPTICAL COMPANY HEALTH 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Plan funding arrangement – Insurance	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes
2011: LACROIX OPTICAL COMPANY HEALTH 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	Plan funding arrangement – Insurance	Yes
2011-06-01	Plan benefit arrangement – Insurance	Yes
2010: LACROIX OPTICAL COMPANY HEALTH 2010 form 5500 responses
2010-06-01	Type of plan entity	Single employer plan
2010-06-01	Plan funding arrangement – Insurance	Yes
2010-06-01	Plan benefit arrangement – Insurance	Yes
2009: LACROIX OPTICAL COMPANY HEALTH 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	This submission is the final filing	No
2009-06-01	Plan funding arrangement – Insurance	Yes
2009-06-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061297

Policy instance

Insurance contract or identification number	061297
Number of Individuals Covered	125
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,462
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000CDFL

Policy instance

Insurance contract or identification number	G000CDFL
Number of Individuals Covered	52
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Total amount of commissions paid to insurance broker	USD $3,806
Total amount of fees paid to insurance company	USD $203
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD VOLUNTARY
Welfare Benefit Premiums Paid to Carrier	USD $25,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027300

Policy instance

Insurance contract or identification number	027300
Number of Individuals Covered	169
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

417002415091

Policy instance

Insurance contract or identification number	417002415091
Number of Individuals Covered	91
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Welfare Benefit Premiums Paid to Carrier	USD $319,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED OF OMAHA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000CDFL

Policy instance

Insurance contract or identification number	G000CDFL
Number of Individuals Covered	98
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Total amount of commissions paid to insurance broker	USD $1,242
Total amount of fees paid to insurance company	USD $69
Other welfare benefits provided	LONG TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $8,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000CDFL

Policy instance

Insurance contract or identification number	G000CDFL
Number of Individuals Covered	87
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Total amount of commissions paid to insurance broker	USD $4,028
Total amount of fees paid to insurance company	USD $223
Other welfare benefits provided	STD
Welfare Benefit Premiums Paid to Carrier	USD $26,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000CDFL

Policy instance

Insurance contract or identification number	G000CDFL
Number of Individuals Covered	99
Insurance policy start date	2023-10-01
Insurance policy end date	2024-09-30
Total amount of commissions paid to insurance broker	USD $1,434
Total amount of fees paid to insurance company	USD $62
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ADD
Welfare Benefit Premiums Paid to Carrier	USD $9,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

417002415901

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027300

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061297

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50047626

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50047626

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50047626

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50047626

Policy instance

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

417002415901

Policy instance

Insurance contract or identification number	417002415901
Number of Individuals Covered	108
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Welfare Benefit Premiums Paid to Carrier	USD $299,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027300

Policy instance

Insurance contract or identification number	027300
Number of Individuals Covered	150
Insurance policy start date	2022-04-01
Insurance policy end date	2022-09-30
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061297

Policy instance

Insurance contract or identification number	061297
Number of Individuals Covered	137
Insurance policy start date	2022-04-01
Insurance policy end date	2022-09-30
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50047626

Policy instance

Insurance contract or identification number	50047626
Number of Individuals Covered	118
Insurance policy start date	2022-04-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $1,223
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD D
Welfare Benefit Premiums Paid to Carrier	USD $4,777

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50047626

Policy instance

Insurance contract or identification number	50047626
Number of Individuals Covered	50
Insurance policy start date	2022-04-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $137
Other welfare benefits provided	VOLUNTARY ADD
Welfare Benefit Premiums Paid to Carrier	USD $490

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50047626

Policy instance

Insurance contract or identification number	50047626
Number of Individuals Covered	92
Insurance policy start date	2022-04-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $3,587
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,978

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

50047626

Policy instance

Insurance contract or identification number	50047626
Number of Individuals Covered	104
Insurance policy start date	2022-04-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $3,961
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,906

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

417002415901

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027300

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061297

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061297

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061297

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027300

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

022945

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

022945

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027300

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061297

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

022945

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027300

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061297

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

022945

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027300

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000ANUI

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

061297

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027300

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

022945

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027300

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0ANUI

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

022945

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

027300

Policy instance

ARKANSAS BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 83470 )

Policy contract number

022945

Policy instance

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0ANUI

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

500000045

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

500000045

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

500000045

Policy instance

USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 )

Policy contract number

500000045

Policy instance

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Company Name:	LACROIX PRECISION OPTICS, INC.
Employer identification number (EIN):	362085033
NAIC Classification:	339900