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TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 401k Plan overview

Plan NameTRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN
Plan identification number 501

TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • 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

TRIAD EYE INSTITUTE, PLLC has sponsored the creation of one or more 401k plans.

Company Name:TRIAD EYE INSTITUTE, PLLC
Employer identification number (EIN):465002052
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-01-01MOLLY STINES2022-05-25
5012020-01-01MOLLY STINES2021-06-02
5012019-01-01MOLLY STINES2020-07-10
5012018-01-01

Plan Statistics for TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN

401k plan membership statisitcs for TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN

Measure Date Value
2021: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01135
Total number of active participants reported on line 7a of the Form 55002021-01-01172
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01172
Number of employers contributing to the scheme2021-01-010
2020: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01117
Total number of active participants reported on line 7a of the Form 55002020-01-01135
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01135
Number of employers contributing to the scheme2020-01-010
2019: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01116
Total number of active participants reported on line 7a of the Form 55002019-01-01117
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01117
Number of employers contributing to the scheme2019-01-010
2018: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01111
Total number of active participants reported on line 7a of the Form 55002018-01-01111
Number of retired or separated participants receiving benefits2018-01-011
Number of other retired or separated participants entitled to future benefits2018-01-011
Total of all active and inactive participants2018-01-01113
Number of employers contributing to the scheme2018-01-010

Form 5500 Responses for TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN

2021: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01First time form 5500 has been submittedYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155987
Policy instance 3
Insurance contract or identification number155987
Number of Individuals Covered160
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $9,078
Total amount of fees paid to insurance companyUSD $4,472
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,078
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1930
Policy instance 2
Insurance contract or identification number1930
Number of Individuals Covered121
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $6,982
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,982
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )
Policy contract number278202
Policy instance 1
Insurance contract or identification number278202
Number of Individuals Covered144
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $34,850
Total amount of fees paid to insurance companyUSD $4,875
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $697,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $34,850
Amount paid for insurance broker fees4875
Additional information about fees paid to insurance brokerSPECIAL PROGRAMS
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155987
Policy instance 4
Insurance contract or identification number155987
Number of Individuals Covered135
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $8,757
Total amount of fees paid to insurance companyUSD $1,975
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,757
Amount paid for insurance broker fees1975
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberTRIAD EYE
Policy instance 3
Insurance contract or identification numberTRIAD EYE
Number of Individuals Covered78
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $1,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1930
Policy instance 2
Insurance contract or identification number1930
Number of Individuals Covered99
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $5,966
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,966
Amount paid for insurance broker fees0
Insurance broker organization code?3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberC03209
Policy instance 1
Insurance contract or identification numberC03209
Number of Individuals Covered110
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $33,495
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $570,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees33495
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155987
Policy instance 4
Insurance contract or identification number155987
Number of Individuals Covered120
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $8,167
Total amount of fees paid to insurance companyUSD $3,776
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,167
Amount paid for insurance broker fees3776
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberTRIAD EYE
Policy instance 3
Insurance contract or identification numberTRIAD EYE
Number of Individuals Covered74
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $1,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1930
Policy instance 2
Insurance contract or identification number1930
Number of Individuals Covered89
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $5,352
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,352
Amount paid for insurance broker fees0
Insurance broker organization code?3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberC03209
Policy instance 1
Insurance contract or identification numberC03209
Number of Individuals Covered102
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $29,295
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $570,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,295
Insurance broker organization code?3
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number155987
Policy instance 3
Insurance contract or identification number155987
Number of Individuals Covered111
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $7,807
Total amount of fees paid to insurance companyUSD $1,610
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $87,552
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,807
Amount paid for insurance broker fees460
Additional information about fees paid to insurance brokerCONTINGENT COMPENSATION
Insurance broker organization code?3
DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )
Policy contract number1930
Policy instance 2
Insurance contract or identification number1930
Number of Individuals Covered87
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $6,321
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,321
Amount paid for insurance broker fees0
Insurance broker organization code?3
COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 1001 )
Policy contract numberC03209
Policy instance 1
Insurance contract or identification numberC03209
Number of Individuals Covered95
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $28,840
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $518,056
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees28840
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3

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