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| Plan Name | TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | TRIAD EYE INSTITUTE, PLLC |
| Employer identification number (EIN): | 465002052 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2021-01-01 | MOLLY STINES | 2022-05-25 | ||
| 501 | 2020-01-01 | MOLLY STINES | 2021-06-02 | ||
| 501 | 2019-01-01 | MOLLY STINES | 2020-07-10 | ||
| 501 | 2018-01-01 |
| 2021: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2021 form 5500 responses | ||
|---|---|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2020 form 5500 responses | ||
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2019 form 5500 responses | ||
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: TRIAD EYE INSTITUTE, PLLC GROUP HEALTH PLAN 2018 form 5500 responses | ||
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | First time form 5500 has been submitted | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) | |
| Policy contract number | 155987 |
| Policy instance | 3 |
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) | |
| Policy contract number | 1930 |
| Policy instance | 2 |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |
| Policy contract number | 278202 |
| Policy instance | 1 |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) | |
| Policy contract number | 155987 |
| Policy instance | 4 |
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) | |
| Policy contract number | TRIAD EYE |
| Policy instance | 3 |
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) | |
| Policy contract number | 1930 |
| Policy instance | 2 |
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) | |
| Policy contract number | C03209 |
| Policy instance | 1 |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) | |
| Policy contract number | 155987 |
| Policy instance | 4 |
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) | |
| Policy contract number | TRIAD EYE |
| Policy instance | 3 |
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) | |
| Policy contract number | 1930 |
| Policy instance | 2 |
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) | |
| Policy contract number | C03209 |
| Policy instance | 1 |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) | |
| Policy contract number | 155987 |
| Policy instance | 3 |
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 ) | |
| Policy contract number | 1930 |
| Policy instance | 2 |
| COMMUNITY CARE (National Association of Insurance Commissioners NAIC id number: 10001 ) | |
| Policy contract number | C03209 |
| Policy instance | 1 |
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