401k Plan data: EYESIGHT HOLDING CO., LLC 401(K) PLAN plan

EYESIGHT HOLDING CO., LLC 401(K) PLAN 401k Plan overview

Plan Name	EYESIGHT HOLDING CO., LLC 401(K) PLAN
Plan identification number	001

EYESIGHT HOLDING CO., LLC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

EYESIGHT HOLDING CO., LLC has sponsored the creation of one or more 401k plans.

Company Name: EYESIGHT HOLDING CO., LLC

Employer identification number (EIN): 832511512

NAIC Classification: 551112
NAIC Description: Offices of Other Holding Companies

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EYESIGHT HOLDING CO., LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2020-01-01
001 2019-01-01
001 2019-01-01

Plan Statistics for EYESIGHT HOLDING CO., LLC 401(K) PLAN

401k plan membership statisitcs for EYESIGHT HOLDING CO., LLC 401(K) PLAN

Measure Date Value
2022: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 979
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 612
Number of retired or separated participants receiving benefits 2022-01-01 8
Number of other retired or separated participants entitled to future benefits 2022-01-01 209
Total of all active and inactive participants 2022-01-01 829
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 829
Number of participants with account balances 2022-01-01 651
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 67
2021: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 837
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 492
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 255
Total of all active and inactive participants 2021-01-01 747
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 747
Number of participants with account balances 2021-01-01 644
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 74
2020: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 602
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 460
Number of retired or separated participants receiving benefits 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 154
Total of all active and inactive participants 2020-01-01 615
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 615
Number of participants with account balances 2020-01-01 465
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 24
2019: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 344
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 393
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 79
Total of all active and inactive participants 2019-01-01 473
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 473
Number of participants with account balances 2019-01-01 327
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 27

Measure	Date	Value
2022: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	979
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	612
Number of retired or separated participants receiving benefits	2022-01-01	8
Number of other retired or separated participants entitled to future benefits	2022-01-01	209
Total of all active and inactive participants	2022-01-01	829
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	829
Number of participants with account balances	2022-01-01	651
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	67
2021: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	837
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	492
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	255
Total of all active and inactive participants	2021-01-01	747
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	747
Number of participants with account balances	2021-01-01	644
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	74
2020: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	602
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	460
Number of retired or separated participants receiving benefits	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	154
Total of all active and inactive participants	2020-01-01	615
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	615
Number of participants with account balances	2020-01-01	465
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	24
2019: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	344
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	393
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	79
Total of all active and inactive participants	2019-01-01	473
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	473
Number of participants with account balances	2019-01-01	327
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	27

Financial Data on EYESIGHT HOLDING CO., LLC 401(K) PLAN

Measure	Date	Value
2022 : EYESIGHT HOLDING CO., LLC 401(K) PLAN 2022 401k financial data
Total income from all sources (including contributions)	2022-12-31	$1,534,750
Total of all expenses incurred	2022-12-31	$838,839
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$694,199
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$2,660,171
Value of total assets at end of year	2022-12-31	$7,036,655
Value of total assets at beginning of year	2022-12-31	$6,340,744
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$144,640
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Administrative expenses professional fees incurred	2022-12-31	$13,905
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$784,896
Participant contributions at end of year	2022-12-31	$32,131
Participant contributions at beginning of year	2022-12-31	$25,186
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$48,850
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$695,911
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$7,036,655
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$6,340,744
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Investment advisory and management fees	2022-12-31	$73,723
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$6,933,693
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$6,254,758
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$54,956
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$48,794
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,125,421
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$1,826,425
Employer contributions (assets) at end of year	2022-12-31	$15,875
Employer contributions (assets) at beginning of year	2022-12-31	$12,006
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$694,199
Contract administrator fees	2022-12-31	$57,012
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	WEAVER & TIDWELL LLP
Accountancy firm EIN	2022-12-31	750178631
2021 : EYESIGHT HOLDING CO., LLC 401(K) PLAN 2021 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$967
Total income from all sources (including contributions)	2021-12-31	$2,825,277
Total of all expenses incurred	2021-12-31	$394,294
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$290,561
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$2,133,980
Value of total assets at end of year	2021-12-31	$6,340,744
Value of total assets at beginning of year	2021-12-31	$3,910,728
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$103,733
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$1,499,675
Participant contributions at end of year	2021-12-31	$25,186
Participant contributions at beginning of year	2021-12-31	$17,800
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$967
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$2,430,983
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$6,340,744
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$3,909,761
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$6,254,758
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$3,859,722
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$48,794
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$25,016
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$691,297
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$634,305
Employer contributions (assets) at end of year	2021-12-31	$12,006
Employer contributions (assets) at beginning of year	2021-12-31	$8,190
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$290,561
Contract administrator fees	2021-12-31	$103,733
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	WEAVER & TIDWELL LLP
Accountancy firm EIN	2021-12-31	750178631
2020 : EYESIGHT HOLDING CO., LLC 401(K) PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$967
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$592
Total income from all sources (including contributions)	2020-12-31	$2,143,974
Total of all expenses incurred	2020-12-31	$235,046
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$183,441
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,608,010
Value of total assets at end of year	2020-12-31	$3,910,728
Value of total assets at beginning of year	2020-12-31	$2,001,425
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$51,605
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$1,035,817
Participant contributions at end of year	2020-12-31	$17,800
Participant contributions at beginning of year	2020-12-31	$41,008
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$119,859
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$967
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$592
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$1,908,928
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$3,909,761
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$2,000,833
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$37,074
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$3,859,722
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$1,939,901
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$25,016
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$3,294
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$535,964
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$452,334
Employer contributions (assets) at end of year	2020-12-31	$8,190
Employer contributions (assets) at beginning of year	2020-12-31	$17,222
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$183,441
Contract administrator fees	2020-12-31	$14,531
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	WEAVER & TIDWELL LLP
Accountancy firm EIN	2020-12-31	750178631
2019 : EYESIGHT HOLDING CO., LLC 401(K) PLAN 2019 401k financial data
Total transfer of assets to this plan	2019-12-31	$408,690
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$592
Total income from all sources (including contributions)	2019-12-31	$1,631,218
Total of all expenses incurred	2019-12-31	$39,075
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$15,748
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,419,820
Value of total assets at end of year	2019-12-31	$2,001,425
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$23,327
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	No
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$792,028
Participant contributions at end of year	2019-12-31	$41,008
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$271,776
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$592
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$1,592,143
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$2,000,833
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Investment advisory and management fees	2019-12-31	$16,730
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$1,939,901
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$3,294
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$211,398
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$356,016
Employer contributions (assets) at end of year	2019-12-31	$17,222
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$15,748
Contract administrator fees	2019-12-31	$6,597
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	WEAVER & TIDWELL LLP
Accountancy firm EIN	2019-12-31	750178631

Form 5500 Responses for EYESIGHT HOLDING CO., LLC 401(K) PLAN

2022: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: EYESIGHT HOLDING CO., LLC 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Submission has been amended	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

871-80513

Policy instance

Insurance contract or identification number	871-80513
Number of Individuals Covered	651
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

871-80513

Policy instance

Insurance contract or identification number	871-80513
Number of Individuals Covered	644
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $38
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

871-80513

Policy instance

Insurance contract or identification number	871-80513
Number of Individuals Covered	465
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $66
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $66
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

871-80513

Policy instance

Insurance contract or identification number	871-80513
Number of Individuals Covered	327
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7
Insurance broker organization code?	3

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Company Name:	EYESIGHT HOLDING CO., LLC
Employer identification number (EIN):	832511512
NAIC Classification:	551112
NAIC Description:	Offices of Other Holding Companies