401k Plan data: EDVISIONS COOPERATIVE VISION INSURANCE plan

EDVISIONS COOPERATIVE VISION INSURANCE 401k Plan overview

Plan Name	EDVISIONS COOPERATIVE VISION INSURANCE
Plan identification number	801

EDVISIONS COOPERATIVE VISION INSURANCE Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Vision

401k Sponsoring company profile

EDVISIONS COOPERATIVE has sponsored the creation of one or more 401k plans.

Company Name: EDVISIONS COOPERATIVE

Employer identification number (EIN): 411812791

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EDVISIONS COOPERATIVE VISION INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
801 2017-07-01 KAY INGLETT KAY INGLETT 2019-01-28
801 2017-07-01 KAY W. INGLETT 2020-12-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
801	2017-07-01	KAY INGLETT		KAY INGLETT	2019-01-28
801	2017-07-01	KAY W. INGLETT	2020-12-09

Plan Statistics for EDVISIONS COOPERATIVE VISION INSURANCE

401k plan membership statisitcs for EDVISIONS COOPERATIVE VISION INSURANCE

Measure Date Value
2017: EDVISIONS COOPERATIVE VISION INSURANCE 2017 401k membership
Total participants, beginning-of-year 2017-07-01 111
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 111
Total of all active and inactive participants 2017-07-01 111
Total participants 2017-07-01 111
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 0

Measure	Date	Value
2017: EDVISIONS COOPERATIVE VISION INSURANCE 2017 401k membership
Total participants, beginning-of-year	2017-07-01	111
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	111
Total of all active and inactive participants	2017-07-01	111
Total participants	2017-07-01	111
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	0

Form 5500 Responses for EDVISIONS COOPERATIVE VISION INSURANCE

2017: EDVISIONS COOPERATIVE VISION INSURANCE 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	First time form 5500 has been submitted	Yes
2017-07-01	Submission has been amended	No
2017-07-01	This submission is the final filing	No
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-07-01	Plan is a collectively bargained plan	No
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

50790-1386

Policy instance

Insurance contract or identification number	50790-1386
Number of Individuals Covered	111
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $1,092
Are there contracts with allocated funds for individual policies?	0
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $10,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

507901386

Policy instance

Insurance contract or identification number	507901386
Number of Individuals Covered	111
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $1,092
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $10,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	EDVISIONS COOPERATIVE
Employer identification number (EIN):	411812791
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services