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EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NameEYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN
Plan identification number 501

EYE CENTER OF NORTHERN COLORADO EMPLOYEE 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)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

EYE CENTER OF NORTHERN COLORADO, P.C. has sponsored the creation of one or more 401k plans.

Company Name:EYE CENTER OF NORTHERN COLORADO, P.C.
Employer identification number (EIN):840675076
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Additional information about EYE CENTER OF NORTHERN COLORADO, P.C.

Jurisdiction of Incorporation: Colorado Department of State
Incorporation Date: 1974-07-01
Company Identification Number: 19871275012
Legal Registered Office Address: 3151 Precision Drive

Fort Collins
United States of America (USA)
80528

More information about EYE CENTER OF NORTHERN COLORADO, P.C.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01KRYSTAL THAN2023-10-02
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01CAROL WITTMER
5012016-01-01CAROL WITTMER
5012015-01-01CAROL WITTMER
5012014-01-01CAROL WITTMER

Plan Statistics for EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01231
Total number of active participants reported on line 7a of the Form 55002022-01-01540
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01540
Number of employers contributing to the scheme2022-01-010
2021: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01208
Total number of active participants reported on line 7a of the Form 55002021-01-01231
Total of all active and inactive participants2021-01-01231
Total participants2021-01-01231
2020: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01180
Total number of active participants reported on line 7a of the Form 55002020-01-01208
Total of all active and inactive participants2020-01-01208
Total participants2020-01-01208
2019: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01160
Total number of active participants reported on line 7a of the Form 55002019-01-01180
Total of all active and inactive participants2019-01-01180
Total participants2019-01-01180
2018: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01137
Total number of active participants reported on line 7a of the Form 55002018-01-01160
Total of all active and inactive participants2018-01-01160
Total participants2018-01-01160
2017: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01119
Total number of active participants reported on line 7a of the Form 55002017-01-01137
Total of all active and inactive participants2017-01-01137
Total participants2017-01-01137
2016: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01118
Total number of active participants reported on line 7a of the Form 55002016-01-01119
Total of all active and inactive participants2016-01-01119
Total participants2016-01-01119
2015: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01118
Total number of active participants reported on line 7a of the Form 55002015-01-01118
Total of all active and inactive participants2015-01-01118
Total participants2015-01-010
2014: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0197
Total number of active participants reported on line 7a of the Form 55002014-01-01118
Total of all active and inactive participants2014-01-01118
Total participants2014-01-010

Form 5500 Responses for EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN

2022: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: EYE CENTER OF NORTHERN COLORADO EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01First time form 5500 has been submittedYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDS0C2V6
Policy instance 1
Insurance contract or identification numberGUDS0C2V6
Number of Individuals Covered540
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $50,776
Total amount of fees paid to insurance companyUSD $17,966
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $499,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,268
Amount paid for insurance broker fees17966
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
ANTHEM (National Association of Insurance Commissioners NAIC id number: 62111 )
Policy contract numberDD1401A001
Policy instance 2
Insurance contract or identification numberDD1401A001
Number of Individuals Covered231
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $158,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number02406
Policy instance 1
Insurance contract or identification number02406
Number of Individuals Covered231
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $186,127
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $604,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $186,127
Insurance broker organization code?3
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number02406
Policy instance 2
Insurance contract or identification number02406
Number of Individuals Covered208
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $161,359
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $657,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $130,316
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000578
Policy instance 1
Insurance contract or identification number1000578
Number of Individuals Covered208
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,479
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedMGD ORGAN/TISSUE TRANSPLANT BENEFIT
Welfare Benefit Premiums Paid to CarrierUSD $14,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,479
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000578
Policy instance 1
Insurance contract or identification number1000578
Number of Individuals Covered180
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,329
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedMGD ORGAN/TISSUE TRANSPLANT BENEFIT
Welfare Benefit Premiums Paid to CarrierUSD $13,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,329
Insurance broker organization code?3
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number02406
Policy instance 2
Insurance contract or identification number02406
Number of Individuals Covered180
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $152,716
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $553,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $123,694
Insurance broker organization code?3
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number02406
Policy instance 2
Insurance contract or identification number02406
Number of Individuals Covered160
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $119,058
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $410,713
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $93,925
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000578
Policy instance 1
Insurance contract or identification number1000578
Number of Individuals Covered160
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedMGD ORGAN/TISSUE TRANSPLANT BENEFIT
Welfare Benefit Premiums Paid to CarrierUSD $11,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number02406
Policy instance 2
Insurance contract or identification number02406
Number of Individuals Covered137
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $82,799
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $387,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,337
Insurance broker organization code?3
Insurance broker nameDAVID A HAASE
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000578
Policy instance 1
Insurance contract or identification number1000578
Number of Individuals Covered137
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $939
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedMGD ORGAN/TISSUE TRANSPLANT BENEFIT
Welfare Benefit Premiums Paid to CarrierUSD $9,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $939
Insurance broker organization code?3
Insurance broker nameUNITED HEALTHCARE INSURANCE COMPANY
GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number15-235
Policy instance 1
Insurance contract or identification number15-235
Number of Individuals Covered118
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $8,459
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $169,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,459
Insurance broker organization code?3
Insurance broker nameCANYON RE,LLC
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL30833
Policy instance 1
Insurance contract or identification numberHCL30833
Number of Individuals Covered118
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,680
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $167,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,680
Insurance broker organization code?3
Insurance broker nameMERITAIN HEALTH

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