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| Plan Name | NATIONWIDE OPTOMETRY EMPLOYEE HEALTH & WELFARE BENEFITS PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | NATIONWIDE OPTOMETRY, P.C. |
| Employer identification number (EIN): | 463499154 |
| 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 | 2021-01-01 | JOE SCHUSTER | 2022-10-12 | ||
| 501 | 2021-01-01 | ANN M. BUSCAVAGE | 2024-02-02 |
| Measure | Date | Value |
|---|---|---|
| 2021: NATIONWIDE OPTOMETRY EMPLOYEE HEALTH & WELFARE BENEFITS PLAN 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-01-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 105 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 105 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2021: NATIONWIDE OPTOMETRY EMPLOYEE HEALTH & WELFARE BENEFITS PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| DELTA DENTAL OF MISSOURI (National Association of Insurance Commissioners NAIC id number: 55697 ) | |
| Policy contract number | 22680000 |
| Policy instance | 1 |
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) | |
| Policy contract number | 3004658 |
| Policy instance | 2 |
| RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 ) | |
| Policy contract number | 69722-2 |
| Policy instance | 3 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) | |
| Policy contract number | SA3890LFG0515 |
| Policy instance | 4 |
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