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NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 401k Plan overview

Plan NameNU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN
Plan identification number 501

NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

NU VISION HOLDINGS, L.L.C. has sponsored the creation of one or more 401k plans.

Company Name:NU VISION HOLDINGS, L.L.C.
Employer identification number (EIN):363961693
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012014-01-01TIFFANY JORDAN TIFFANY JORDAN2015-09-28
5012014-01-01TIFFANY JORDAN
5012014-01-01TIFFANY JORDAN TIFFANY JORDAN2016-08-05
5012013-01-01FLORA REZNIK FLORA REZNIK2014-09-15
5012012-01-01FLORA REZNIK FLORA REZNIK2013-10-14
5012011-01-01FLORA REZNIK FLORA REZNIK2012-10-10
5012010-01-01FLORA REZNIK FLORA REZNIK2011-10-03
5012009-01-01FLORA REZNIK FLORA REZNIK2010-08-19

Plan Statistics for NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN

401k plan membership statisitcs for NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN

Measure Date Value
2014: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01596
Total number of active participants reported on line 7a of the Form 55002014-01-011,287
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-011,287
2013: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01633
Total number of active participants reported on line 7a of the Form 55002013-01-01596
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01596
2012: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01633
Total number of active participants reported on line 7a of the Form 55002012-01-01633
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01633
2011: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01623
Total number of active participants reported on line 7a of the Form 55002011-01-01633
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01633
2010: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01638
Total number of active participants reported on line 7a of the Form 55002010-01-01623
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01623
2009: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,084
Total number of active participants reported on line 7a of the Form 55002009-01-01638
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01638
Total participants2009-01-010

Form 5500 Responses for NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN

2014: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: NU VISION HOLDINGS, L.L.C. EMPLOYEES' HEALTH BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract numberOM4054 B94054
Policy instance 3
Insurance contract or identification numberOM4054 B94054
Number of Individuals Covered163
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $36,987
Total amount of fees paid to insurance companyUSD $374
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Dental Insurance Welfare BenefitNo
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 $929,880
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00470845
Policy instance 1
Insurance contract or identification number00470845
Number of Individuals Covered1287
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $30,722
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $307,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,722
Insurance broker organization code?3
Insurance broker nameROBINSON FINANCIAL GROUP
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00470845
Policy instance 2
Insurance contract or identification number00470845
Number of Individuals Covered664
Insurance policy start date2014-10-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $2,916
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 providedAD & D
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 $29,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00470845
Policy instance 1
Insurance contract or identification number00470845
Number of Individuals Covered668
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $35,273
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 providedAD & D
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 $352,733
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number123322
Policy instance 4
Insurance contract or identification number123322
Number of Individuals Covered380
Insurance policy start date2013-12-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $74,551
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Dental Insurance Welfare BenefitNo
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 $2,520,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0706458
Policy instance 1
Insurance contract or identification number0706458
Number of Individuals Covered222
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $18,549
Total amount of fees paid to insurance companyUSD $130
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $261,632
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,549
Amount paid for insurance broker fees130
Additional information about fees paid to insurance brokerBONUS PAYMENT
Insurance broker organization code?3
Insurance broker nameROBINSON FINANCIAL GROUP INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00470845
Policy instance 2
Insurance contract or identification number00470845
Number of Individuals Covered596
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $31,492
Total amount of fees paid to insurance companyUSD $8,324
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $314,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,492
Amount paid for insurance broker fees8324
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker nameROBINSON FINANCIAL GROUP
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0706458
Policy instance 1
Insurance contract or identification number0706458
Number of Individuals Covered633
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $111,742
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,051,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $102,692
Insurance broker organization code?3
Additional information about fees paid to insurance brokerBONUS AMOUNT
Insurance broker nameROBINSON FINANCIAL GROUP, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00470845
Policy instance 2
Insurance contract or identification number00470845
Number of Individuals Covered544
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Total amount of commissions paid to insurance brokerUSD $34,944
Total amount of fees paid to insurance companyUSD $4,180
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $349,441
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,944
Amount paid for insurance broker fees4180
Additional information about fees paid to insurance brokerGENERAL FEES PAID
Insurance broker organization code?3
Insurance broker nameROBINSON FINANCIAL GROUP
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0706458
Policy instance 1
Insurance contract or identification number0706458
Number of Individuals Covered633
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of commissions paid to insurance brokerUSD $181,925
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,361,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )
Policy contract number10863
Policy instance 2
Insurance contract or identification number10863
Number of Individuals Covered633
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Total amount of commissions paid to insurance brokerUSD $43,182
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $432,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0706458
Policy instance 1
Insurance contract or identification number0706458
Number of Individuals Covered623
Insurance policy start date2009-09-01
Insurance policy end date2010-08-31
Total amount of commissions paid to insurance brokerUSD $168,046
Total amount of fees paid to insurance companyUSD $14,250
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,321,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $168,046
Amount paid for insurance broker fees14250
Additional information about fees paid to insurance brokerBONUS AMOUNT
Insurance broker organization code?3
Insurance broker nameROBINSON FINANCIAL GROUP INC.
DELTA DENTAL OF ILLINOIS (National Association of Insurance Commissioners NAIC id number: 47589 )
Policy contract number10863
Policy instance 2
Insurance contract or identification number10863
Number of Individuals Covered623
Insurance policy start date2009-10-01
Insurance policy end date2010-09-30
Total amount of commissions paid to insurance brokerUSD $40,892
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $406,654
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,892
Insurance broker organization code?3
Insurance broker nameROBINSON FINANCIAL GROUP

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