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| Plan Name | TRIAD EYE INSTITUTE, PLLC |
| Plan identification number | 502 |
| 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 |
|---|---|---|---|---|---|
| 502 | 2023-01-01 | JENNIFER ANDERSON | 2024-09-16 |
| 2023: TRIAD EYE INSTITUTE, PLLC 2023 form 5500 responses | ||
|---|---|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | First time form 5500 has been submitted | Yes |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 ) | |||||||||||||||||||||
| Policy contract number | 278202 | ||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||
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| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) | |||||||||||||||||||||
| Policy contract number | 10370581001 | ||||||||||||||||||||
| Policy instance | 2 | ||||||||||||||||||||
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| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) | |||||||||||||||||||||
| Policy contract number | GLUG0C42S | ||||||||||||||||||||
| Policy instance | 3 | ||||||||||||||||||||
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