401k Plan data: ACCRIVA DIAGNOSTICS VISION PLAN plan

ACCRIVA DIAGNOSTICS VISION PLAN 401k Plan overview

Plan Name	ACCRIVA DIAGNOSTICS VISION PLAN
Plan identification number	503

ACCRIVA DIAGNOSTICS VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision

401k Sponsoring company profile

ACCRIVA DIAGNOSTICS HOLDINGS, INC. has sponsored the creation of one or more 401k plans.

Company Name: ACCRIVA DIAGNOSTICS HOLDINGS, INC.

Employer identification number (EIN): 320321832

NAIC Classification: 339110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ACCRIVA DIAGNOSTICS VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2018-01-01
503 2017-01-01
503 2016-01-01 HOLLY TRAN
503 2015-01-01 HOLLY TRAN
503 2014-01-01 HOLLY TRAN
503 2013-01-01 HOLLY TRAN
503 2012-01-01 HOLLY TRAN
503 2011-01-01 HOLLY TRAN

Plan Statistics for ACCRIVA DIAGNOSTICS VISION PLAN

401k plan membership statisitcs for ACCRIVA DIAGNOSTICS VISION PLAN

Measure Date Value
2018: ACCRIVA DIAGNOSTICS VISION PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 154
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0
Number of employers contributing to the scheme 2018-01-01 0
2017: ACCRIVA DIAGNOSTICS VISION PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 339
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 151
Number of retired or separated participants receiving benefits 2017-01-01 3
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 154
2016: ACCRIVA DIAGNOSTICS VISION PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 321
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 336
Number of retired or separated participants receiving benefits 2016-01-01 3
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 339
2015: ACCRIVA DIAGNOSTICS VISION PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 275
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 314
Number of retired or separated participants receiving benefits 2015-01-01 10
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 324
2014: ACCRIVA DIAGNOSTICS VISION PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 338
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 280
Number of retired or separated participants receiving benefits 2014-01-01 2
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 282
2013: ACCRIVA DIAGNOSTICS VISION PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 404
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 344
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 2013-01-01 344
2012: ACCRIVA DIAGNOSTICS VISION PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 441
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 404
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 2012-01-01 404
2011: ACCRIVA DIAGNOSTICS VISION PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 470
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 441
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 2011-01-01 441

Measure	Date	Value
2018: ACCRIVA DIAGNOSTICS VISION PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	154
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
Number of employers contributing to the scheme	2018-01-01	0
2017: ACCRIVA DIAGNOSTICS VISION PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	339
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	151
Number of retired or separated participants receiving benefits	2017-01-01	3
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	154
2016: ACCRIVA DIAGNOSTICS VISION PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	321
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	336
Number of retired or separated participants receiving benefits	2016-01-01	3
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	339
2015: ACCRIVA DIAGNOSTICS VISION PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	275
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	314
Number of retired or separated participants receiving benefits	2015-01-01	10
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	324
2014: ACCRIVA DIAGNOSTICS VISION PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	338
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	280
Number of retired or separated participants receiving benefits	2014-01-01	2
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	282
2013: ACCRIVA DIAGNOSTICS VISION PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	404
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	344
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	344
2012: ACCRIVA DIAGNOSTICS VISION PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	441
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	404
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	404
2011: ACCRIVA DIAGNOSTICS VISION PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	470
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	441
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	441

Form 5500 Responses for ACCRIVA DIAGNOSTICS VISION PLAN

2018: ACCRIVA DIAGNOSTICS VISION PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	This submission is the final filing	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: ACCRIVA DIAGNOSTICS VISION PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: ACCRIVA DIAGNOSTICS VISION PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: ACCRIVA DIAGNOSTICS VISION 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	No
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 benefit arrangement – Insurance	Yes
2014: ACCRIVA DIAGNOSTICS VISION 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 – General assets of the sponsor	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: ACCRIVA DIAGNOSTICS VISION 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 – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: ACCRIVA DIAGNOSTICS VISION 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 – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: ACCRIVA DIAGNOSTICS VISION PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	First time form 5500 has been submitted	Yes
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 – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

30047460

Policy instance

Insurance contract or identification number	30047460
Number of Individuals Covered	294
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $2,752
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $45,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,007
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: )

Policy contract number

30047460

Policy instance

Insurance contract or identification number	30047460
Number of Individuals Covered	354
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,679
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,264
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,713
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	MATTHEW A. MADZOEFF

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Company Name:	ACCRIVA DIAGNOSTICS HOLDINGS, INC.
Employer identification number (EIN):	320321832
NAIC Classification:	339110