401k Plan data: MIDWEST EYE CONSULTANTS, P.C. WELFARE BENEFIT PLAN plan

MIDWEST EYE CONSULTANTS, P.C. WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	MIDWEST EYE CONSULTANTS, P.C. WELFARE BENEFIT PLAN
Plan identification number	503

MIDWEST EYE CONSULTANTS, P.C. WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare 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

BRIDGEVIEW EYE PARTNERS has sponsored the creation of one or more 401k plans.

Company Name: BRIDGEVIEW EYE PARTNERS

Employer identification number (EIN): 351845786

NAIC Classification: 111100
NAIC Description: Oilseed and Grain Farming

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MIDWEST EYE CONSULTANTS, P.C. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2023-01-01 CATHY GARRETT-SMITH 2024-10-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
503	2023-01-01	CATHY GARRETT-SMITH	2024-10-09

Plan Statistics for MIDWEST EYE CONSULTANTS, P.C. WELFARE BENEFIT PLAN

401k plan membership statisitcs for MIDWEST EYE CONSULTANTS, P.C. WELFARE BENEFIT PLAN

Measure Date Value
2023: MIDWEST EYE CONSULTANTS, P.C. WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 108
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 9
Total of all active and inactive participants 2023-01-01 117
Number of employers contributing to the scheme 2023-01-01 0

Measure	Date	Value
2023: MIDWEST EYE CONSULTANTS, P.C. WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	108
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	9
Total of all active and inactive participants	2023-01-01	117
Number of employers contributing to the scheme	2023-01-01	0

Form 5500 Responses for MIDWEST EYE CONSULTANTS, P.C. WELFARE BENEFIT PLAN

2023: MIDWEST EYE CONSULTANTS, P.C. WELFARE BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	First time form 5500 has been submitted	Yes
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )

Policy contract number

L07011

Policy instance

Insurance contract or identification number	L07011
Number of Individuals Covered	172
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $27,107
Total amount of fees paid to insurance company	USD $521
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $989,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM0612148

Policy instance

Insurance contract or identification number	SGM0612148
Number of Individuals Covered	108
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $12,001
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM, ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $68,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

Potentially related plans

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Company Name:	BRIDGEVIEW EYE PARTNERS
Employer identification number (EIN):	351845786
NAIC Classification:	111100
NAIC Description:	Oilseed and Grain Farming