|
EMPLOYEE GROUP MEDICAL INSURANCE PLAN
|
2021
|
593401517
|
2024-04-25
|
FLORIDA EYE ASSOCIATES
|
99
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
503
|
| Effective date of plan |
2011-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3217272020
|
| Plan sponsor’s mailing address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
| Plan sponsor’s
address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
Number of participants as of the end of the plan year
| Active participants |
0 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2024-04-25 |
| Name of individual signing |
SUZANNE LEE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
EMPLOYEE GROUP LIFE INSURANCE PLAN
|
2021
|
593401517
|
2024-04-25
|
FLORIDA EYE ASSOCIATES
|
130
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2011-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3217272020
|
| Plan sponsor’s mailing address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
| Plan sponsor’s
address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
Number of participants as of the end of the plan year
| Active participants |
0 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2024-04-25 |
| Name of individual signing |
SUZANNE LEE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
EMPLOYEE GROUP DENTAL INSURANCE PLAN
|
2021
|
593401517
|
2024-04-25
|
FLORIDA EYE ASSOCIATES
|
103
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2006-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3217272020
|
| Plan sponsor’s mailing address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
| Plan sponsor’s
address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
Number of participants as of the end of the plan year
| Active participants |
0 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2024-04-25 |
| Name of individual signing |
SUZANNE LEE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
EMPLOYEE GROUP MEDICAL INSURANCE PLAN
|
2021
|
593401517
|
2023-03-30
|
FLORIDA EYE ASSOCIATES
|
99
|
|
| Three-digit plan number (PN) |
503
|
| Effective date of plan |
2011-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3217272020
|
| Plan sponsor’s mailing address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
| Plan sponsor’s
address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
Number of participants as of the end of the plan year
| Active participants |
87 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2023-03-30 |
| Name of individual signing |
SUZANNE LEE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
EMPLOYEE GROUP DENTAL INSURANCE PLAN
|
2021
|
593401517
|
2023-03-30
|
FLORIDA EYE ASSOCIATES
|
103
|
|
| Three-digit plan number (PN) |
502
|
| Effective date of plan |
2006-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3217272020
|
| Plan sponsor’s mailing address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
| Plan sponsor’s
address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
Number of participants as of the end of the plan year
| Active participants |
95 |
| Retired or separated participants receiving
benefits |
1 |
| Other
retired or separated participants entitled to future benefits |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2023-03-30 |
| Name of individual signing |
SUZANNE LEE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
EMPLOYEE GROUP LIFE INSURANCE PLAN
|
2021
|
593401517
|
2023-03-30
|
FLORIDA EYE ASSOCIATES
|
130
|
|
| Three-digit plan number (PN) |
501
|
| Effective date of plan |
2011-09-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3217272020
|
| Plan sponsor’s mailing address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
| Plan sponsor’s
address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
Number of participants as of the end of the plan year
| Active participants |
123 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
0 |
Signature of
| Role |
Plan administrator |
| Date |
2023-03-30 |
| Name of individual signing |
SUZANNE LEE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
|
FLORIDA EYE ASSOCIATES INC. 401(K) PLAN
|
2019
|
593401517
|
2021-07-15
|
FLORIDA EYE ASSOCIATES INC.
|
142
|
|
| File |
View Page
|
| Three-digit plan number (PN) |
001
|
| Effective date of plan |
2003-01-01
|
| Business code |
621111
|
| Sponsor’s telephone number |
3217272020
|
| Plan sponsor’s mailing address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
| Plan sponsor’s
address |
502 E NEW HAVEN AVE, MELBOURNE, FL, 329015427
|
Number of participants as of the end of the plan year
| Active participants |
125 |
| Retired or separated participants receiving
benefits |
0 |
| Other
retired or separated participants entitled to future benefits |
8 |
| Deceased participants
whose
beneficiaries are receiving or are entitled to receive benefits |
0 |
| Number of
participants
with
account balances as of the end of the plan year |
98 |
| Number of participants that
terminated
employment during the plan year with accrued benefits that were less than 100%
vested |
10 |
Signature of
| Role |
Plan administrator |
| Date |
2021-07-15 |
| Name of individual signing |
MARY SHANE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
| Role |
Employer/plan sponsor |
| Date |
2021-07-15 |
| Name of individual signing |
MARY SHANE |
| Valid signature |
Filed with authorized/valid electronic signature |
|
|
