401k Plan data: ESSILORLUXOTTICA GROUP BENEFIT PLAN plan

ESSILORLUXOTTICA GROUP BENEFIT PLAN 401k Plan overview

Plan Name	ESSILORLUXOTTICA GROUP BENEFIT PLAN
Plan identification number	522

ESSILORLUXOTTICA GROUP BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

ESSILORLUXOTTICA USA INC has sponsored the creation of one or more 401k plans.

Company Name: ESSILORLUXOTTICA USA INC

Employer identification number (EIN): 863625314

NAIC Classification: 446130
NAIC Description: Optical Goods Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ESSILORLUXOTTICA GROUP BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
522 2023-01-01

Plan Statistics for ESSILORLUXOTTICA GROUP BENEFIT PLAN

401k plan membership statisitcs for ESSILORLUXOTTICA GROUP BENEFIT PLAN

Measure Date Value
2023: ESSILORLUXOTTICA GROUP BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 38,397
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 39,971
Number of retired or separated participants receiving benefits 2023-01-01 156
Total of all active and inactive participants 2023-01-01 40,127

Measure	Date	Value
2023: ESSILORLUXOTTICA GROUP BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	38,397
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	39,971
Number of retired or separated participants receiving benefits	2023-01-01	156
Total of all active and inactive participants	2023-01-01	40,127

Form 5500 Responses for ESSILORLUXOTTICA GROUP BENEFIT PLAN

2023: ESSILORLUXOTTICA GROUP BENEFIT PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

804873G

Policy instance

Insurance contract or identification number	804873G
Number of Individuals Covered	7039
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,501,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )

Policy contract number

212061

Policy instance

Insurance contract or identification number	212061
Number of Individuals Covered	34405
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Other welfare benefits provided	EAP
Welfare Benefit Premiums Paid to Carrier	USD $6,102,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

0700982

Policy instance

Insurance contract or identification number	0700982
Number of Individuals Covered	3306
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,137,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )

Policy contract number

AL00001800

Policy instance

Insurance contract or identification number	AL00001800
Number of Individuals Covered	26969
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,230,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HAWAII MEDICAL SERVICE ASSOCIATION (National Association of Insurance Commissioners NAIC id number: 95804 )

Policy contract number

066173

Policy instance

Insurance contract or identification number	066173
Number of Individuals Covered	159
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $927,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MCS LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60030 )

Policy contract number

79-790685

Policy instance

Insurance contract or identification number	79-790685
Number of Individuals Covered	150
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3191560

Policy instance

Insurance contract or identification number	3191560
Number of Individuals Covered	1565
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Dental Insurance Welfare Benefit	Yes
Other welfare benefits provided	PREPAID DENTAL
Welfare Benefit Premiums Paid to Carrier	USD $269,494
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ESSILORLUXOTTICA USA INC
Employer identification number (EIN):	863625314
NAIC Classification:	446130
NAIC Description:	Optical Goods Stores