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MEDICAL PLAN FOR EMPLOYEES OF JFJ EYECARE DBA QUANTUM VISION CENTERS 401k Plan overview

Plan NameMEDICAL PLAN FOR EMPLOYEES OF JFJ EYECARE DBA QUANTUM VISION CENTERS
Plan identification number 501

MEDICAL PLAN FOR EMPLOYEES OF JFJ EYECARE DBA QUANTUM VISION CENTERS Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Other welfare benefit cover

401k Sponsoring company profile

JFJ EYECARE, LTD. has sponsored the creation of one or more 401k plans.

Company Name:JFJ EYECARE, LTD.
Employer identification number (EIN):371099270
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL PLAN FOR EMPLOYEES OF JFJ EYECARE DBA QUANTUM VISION CENTERS

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-03-01AMIE NESLER AMIE NESLER2017-09-22
5012015-03-01STEPHANIE GABRIEL

Plan Statistics for MEDICAL PLAN FOR EMPLOYEES OF JFJ EYECARE DBA QUANTUM VISION CENTERS

401k plan membership statisitcs for MEDICAL PLAN FOR EMPLOYEES OF JFJ EYECARE DBA QUANTUM VISION CENTERS

Measure Date Value
2016: MEDICAL PLAN FOR EMPLOYEES OF JFJ EYECARE DBA QUANTUM VISION CENTERS 2016 401k membership
Total participants, beginning-of-year2016-03-0192
Total number of active participants reported on line 7a of the Form 55002016-03-010
Number of retired or separated participants receiving benefits2016-03-010
Number of other retired or separated participants entitled to future benefits2016-03-010
Total of all active and inactive participants2016-03-010
2015: MEDICAL PLAN FOR EMPLOYEES OF JFJ EYECARE DBA QUANTUM VISION CENTERS 2015 401k membership
Total participants, beginning-of-year2015-03-01104
Total number of active participants reported on line 7a of the Form 55002015-03-0192
Number of retired or separated participants receiving benefits2015-03-010
Number of other retired or separated participants entitled to future benefits2015-03-010
Total of all active and inactive participants2015-03-0192

Form 5500 Responses for MEDICAL PLAN FOR EMPLOYEES OF JFJ EYECARE DBA QUANTUM VISION CENTERS

2016: MEDICAL PLAN FOR EMPLOYEES OF JFJ EYECARE DBA QUANTUM VISION CENTERS 2016 form 5500 responses
2016-03-01Type of plan entitySingle employer plan
2016-03-01Submission has been amendedNo
2016-03-01This submission is the final filingYes
2016-03-01This return/report is a short plan year return/report (less than 12 months)No
2016-03-01Plan is a collectively bargained planNo
2016-03-01Plan funding arrangement – InsuranceYes
2016-03-01Plan funding arrangement – General assets of the sponsorYes
2016-03-01Plan benefit arrangement – InsuranceYes
2016-03-01Plan benefit arrangement – General assets of the sponsorYes
2015: MEDICAL PLAN FOR EMPLOYEES OF JFJ EYECARE DBA QUANTUM VISION CENTERS 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01First time form 5500 has been submittedYes
2015-03-01Submission has been amendedNo
2015-03-01This submission is the final filingNo
2015-03-01This return/report is a short plan year return/report (less than 12 months)No
2015-03-01Plan is a collectively bargained planNo
2015-03-01Plan funding arrangement – InsuranceYes
2015-03-01Plan funding arrangement – General assets of the sponsorYes
2015-03-01Plan benefit arrangement – InsuranceYes
2015-03-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 )
Policy contract number9582
Policy instance 1
Insurance contract or identification number9582
Number of Individuals Covered93
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $33,103
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $220,693
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,069
Insurance broker organization code?3
Insurance broker nameKEY BENEFIT ADMINISTRATORS
NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 )
Policy contract number949-5918
Policy instance 2
Insurance contract or identification number949-5918
Number of Individuals Covered93
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $1,296
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedTRANSPLANT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $12,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $648
Insurance broker organization code?3
Insurance broker nameKEY BENEFIT ADMINISTRATORS, INC.

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