| Plan Name | DENTAL DEPOT MEDICAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
|
| Company Name: | DENTAL DEPOT DSO, LLC |
| Employer identification number (EIN): | 204886566 |
| NAIC Classification: | 621210 |
| NAIC Description: | Offices of Dentists |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2020-07-01 | DAMON HAYES-MILLIGAN | 2021-08-19 | ||
| 501 | 2020-07-01 | DAMON HAYES-MILLIGAN | 2022-07-08 | ||
| 501 | 2019-07-01 | GLENN ASHMORE | 2021-02-09 | ||
| 501 | 2018-07-01 | MARRIA BRYDON | 2020-01-29 |
| 2020: DENTAL DEPOT MEDICAL PLAN 2020 form 5500 responses | ||
|---|---|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Submission has been amended | Yes |
| 2020-07-01 | This submission is the final filing | Yes |
| 2020-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: DENTAL DEPOT MEDICAL PLAN 2019 form 5500 responses | ||
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: DENTAL DEPOT MEDICAL PLAN 2018 form 5500 responses | ||
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | First time form 5500 has been submitted | Yes |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 778259 |
| Policy instance | 1 |
| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 ) | |
| Policy contract number | 778259HNO |
| Policy instance | 2 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 778259 |
| Policy instance | 1 |
| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 ) | |
| Policy contract number | 778259HNO |
| Policy instance | 2 |
| AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 ) | |
| Policy contract number | 778259HNO |
| Policy instance | 2 |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 778259 |
| Policy instance | 1 |