401k Plan data: A & J EYECARE 401(K) PLAN plan

A & J EYECARE 401(K) PLAN 401k Plan overview

Plan Name	A & J EYECARE 401(K) PLAN
Plan identification number	001

A & J EYECARE 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.

401k Sponsoring company profile

A & J EYECARE, INC. PEARLE VISION CENTER has sponsored the creation of one or more 401k plans.

Company Name: A & J EYECARE, INC. PEARLE VISION CENTER

Employer identification number (EIN): 061146937

NAIC Classification: 621320
NAIC Description: Offices of Optometrists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan A & J EYECARE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 JOSEPH STRIZALKOWSKI JOSEPH STRIZALKOWSKI 2016-07-07
001 2014-01-01 JOSEPH STRIZALKOWSKI JOSEPH STRIZALKOWSKI 2015-10-06
001 2013-01-01 JOSEPH STRIZALKOWSKI JOSEPH STRIZALKOWSKI 2014-08-13
001 2012-01-01 JOSEPH STRIZALKOWSKI JOSEPH STRIZALKOWSKI 2013-07-29
001 2011-01-01 JOSEPH STRIZALKOWSKI JOSEPH STRIZALKOWSKI 2012-07-27
001 2010-01-01 JOSEPH STRIZALKOWSKI JOSEPH STRIZALKOWSKI 2011-07-20
001 2009-01-01 JOSEPH STRIZALKOWSKI JOSEPH STRIZALKOWSKI 2010-08-12

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2015-01-01	JOSEPH STRIZALKOWSKI	JOSEPH STRIZALKOWSKI	2016-07-07
001	2014-01-01	JOSEPH STRIZALKOWSKI	JOSEPH STRIZALKOWSKI	2015-10-06
001	2013-01-01	JOSEPH STRIZALKOWSKI	JOSEPH STRIZALKOWSKI	2014-08-13
001	2012-01-01	JOSEPH STRIZALKOWSKI	JOSEPH STRIZALKOWSKI	2013-07-29
001	2011-01-01	JOSEPH STRIZALKOWSKI	JOSEPH STRIZALKOWSKI	2012-07-27
001	2010-01-01	JOSEPH STRIZALKOWSKI	JOSEPH STRIZALKOWSKI	2011-07-20
001	2009-01-01	JOSEPH STRIZALKOWSKI	JOSEPH STRIZALKOWSKI	2010-08-12

Plan Statistics for A & J EYECARE 401(K) PLAN

401k plan membership statisitcs for A & J EYECARE 401(K) PLAN

Measure Date Value
2015: A & J EYECARE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 0
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 0
Number of participants with account balances 2015-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: A & J EYECARE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 6
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 6
Number of participants with account balances 2014-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: A & J EYECARE 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 6
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 6
Number of participants with account balances 2013-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: A & J EYECARE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 6
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 6
Number of participants with account balances 2012-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: A & J EYECARE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 5
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 5
Number of participants with account balances 2011-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: A & J EYECARE 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 4
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 4
Number of participants with account balances 2010-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: A & J EYECARE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 4
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 4
Number of participants with account balances 2009-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2015: A & J EYECARE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	0
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	0
Number of participants with account balances	2015-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: A & J EYECARE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	6
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	6
Number of participants with account balances	2014-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: A & J EYECARE 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	6
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	6
Number of participants with account balances	2013-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: A & J EYECARE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	6
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	6
Number of participants with account balances	2012-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: A & J EYECARE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	5
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	5
Number of participants with account balances	2011-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: A & J EYECARE 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	4
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	4
Number of participants with account balances	2010-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: A & J EYECARE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	4
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	4
Number of participants with account balances	2009-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on A & J EYECARE 401(K) PLAN

Measure	Date	Value
2015 : A & J EYECARE 401(K) PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$-12,131
Expenses. Total of all expenses incurred	2015-12-31	$258,334
Benefits paid (including direct rollovers)	2015-12-31	$258,334
Total plan assets at end of year	2015-12-31	$0
Total plan assets at beginning of year	2015-12-31	$270,465
Value of fidelity bond covering the plan	2015-12-31	$50,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-12,131
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-270,465
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$270,465
Total contributions received or receivable from employer(s)	2015-12-31	$0
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$0
2014 : A & J EYECARE 401(K) PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$26,364
Expenses. Total of all expenses incurred	2014-12-31	$0
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$270,465
Total plan assets at beginning of year	2014-12-31	$244,101
Value of fidelity bond covering the plan	2014-12-31	$50,000
Total contributions received or receivable from participants	2014-12-31	$13,252
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$13,112
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$26,364
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$270,465
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$244,101
Total contributions received or receivable from employer(s)	2014-12-31	$0
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$0
2013 : A & J EYECARE 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$52,094
Expenses. Total of all expenses incurred	2013-12-31	$0
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$244,101
Total plan assets at beginning of year	2013-12-31	$192,007
Value of fidelity bond covering the plan	2013-12-31	$50,000
Total contributions received or receivable from participants	2013-12-31	$12,492
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$39,602
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$52,094
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$244,101
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$192,007
Assets. Value of participant loans	2013-12-31	$1,667
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
2012 : A & J EYECARE 401(K) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$24,342
Expenses. Total of all expenses incurred	2012-12-31	$0
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$192,007
Total plan assets at beginning of year	2012-12-31	$167,665
Value of fidelity bond covering the plan	2012-12-31	$20,000
Total contributions received or receivable from participants	2012-12-31	$6,726
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$17,616
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$24,342
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$192,007
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$167,665
Assets. Value of participant loans	2012-12-31	$2,917
Total contributions received or receivable from employer(s)	2012-12-31	$0
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
2011 : A & J EYECARE 401(K) PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$-2,591
Expenses. Total of all expenses incurred	2011-12-31	$0
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$167,665
Total plan assets at beginning of year	2011-12-31	$170,256
Value of fidelity bond covering the plan	2011-12-31	$20,000
Total contributions received or receivable from participants	2011-12-31	$3,014
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-5,605
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-2,591
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$167,665
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$170,256
Assets. Value of participant loans	2011-12-31	$3,807
Total contributions received or receivable from employer(s)	2011-12-31	$0
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
2010 : A & J EYECARE 401(K) PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$18,950
Expenses. Total of all expenses incurred	2010-12-31	$0
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$170,256
Total plan assets at beginning of year	2010-12-31	$151,306
Value of fidelity bond covering the plan	2010-12-31	$20,000
Total contributions received or receivable from participants	2010-12-31	$3,239
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$15,711
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$18,950
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$170,256
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$151,306
Assets. Value of participant loans	2010-12-31	$4,935
Total contributions received or receivable from employer(s)	2010-12-31	$0
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0

Form 5500 Responses for A & J EYECARE 401(K) PLAN

2015: A & J EYECARE 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	Yes
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: A & J EYECARE 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: A & J EYECARE 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: A & J EYECARE 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: A & J EYECARE 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: A & J EYECARE 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: A & J EYECARE 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

738596 101

Policy instance

Insurance contract or identification number	738596 101
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	E. PAOLONI

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Company Name:	A & J EYECARE, INC. PEARLE VISION CENTER
Employer identification number (EIN):	061146937
NAIC Classification:	621320
NAIC Description:	Offices of Optometrists