401k Plan data: DENTAL DEPOT DSO WELFARE BENEFIT PLAN plan

DENTAL DEPOT DSO WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	DENTAL DEPOT DSO WELFARE BENEFIT PLAN
Plan identification number	503

DENTAL DEPOT DSO WELFARE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

DENTAL DEPOT DSO, LLC has sponsored the creation of one or more 401k plans.

Company Name: DENTAL DEPOT DSO, LLC

Employer identification number (EIN): 204886566

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DENTAL DEPOT DSO WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2023-01-01 JACK WALDO 2024-07-16
503 2022-01-01 JACK WALDO 2023-08-07
503 2021-01-01 DAMON HAYES-MILLIGAN 2022-07-07
503 2021-01-01 JACK WALDO 2023-08-18

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
503	2023-01-01	JACK WALDO	2024-07-16
503	2022-01-01	JACK WALDO	2023-08-07
503	2021-01-01	DAMON HAYES-MILLIGAN	2022-07-07
503	2021-01-01	JACK WALDO	2023-08-18

Plan Statistics for DENTAL DEPOT DSO WELFARE BENEFIT PLAN

401k plan membership statisitcs for DENTAL DEPOT DSO WELFARE BENEFIT PLAN

Measure Date Value
2023: DENTAL DEPOT DSO WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 396
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 396
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 396
Number of employers contributing to the scheme 2023-01-01 0
2022: DENTAL DEPOT DSO WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 478
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 488
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 488
Number of employers contributing to the scheme 2022-01-01 0
2021: DENTAL DEPOT DSO WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 395
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 395
Number of employers contributing to the scheme 2021-01-01 0

Measure	Date	Value
2023: DENTAL DEPOT DSO WELFARE BENEFIT PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	396
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	396
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	396
Number of employers contributing to the scheme	2023-01-01	0
2022: DENTAL DEPOT DSO WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	478
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	488
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	488
Number of employers contributing to the scheme	2022-01-01	0
2021: DENTAL DEPOT DSO WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	395
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	395
Number of employers contributing to the scheme	2021-01-01	0

Form 5500 Responses for DENTAL DEPOT DSO WELFARE BENEFIT PLAN

2023: DENTAL DEPOT DSO WELFARE 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 benefit arrangement – Insurance	Yes
2022: DENTAL DEPOT DSO WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2021: DENTAL DEPOT DSO WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	First time form 5500 has been submitted	Yes
2021-01-01	Submission has been amended	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10264940

Policy instance

Insurance contract or identification number	10264940
Number of Individuals Covered	100
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $21,906
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $146,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

AGC0000179569

Policy instance

Insurance contract or identification number	AGC0000179569
Number of Individuals Covered	349
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $20,827
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $61,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

275518

Policy instance

Insurance contract or identification number	275518
Number of Individuals Covered	156
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $41,430
Total amount of fees paid to insurance company	USD $1,267
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $830,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05974846

Policy instance

Insurance contract or identification number	KM05974846
Number of Individuals Covered	396
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $6,352
Total amount of fees paid to insurance company	USD $656
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $35,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

99428551001

Policy instance

Insurance contract or identification number	99428551001
Number of Individuals Covered	529
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $2,616
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10264940

Policy instance

Insurance contract or identification number	10264940
Number of Individuals Covered	93
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $17,835
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Welfare Benefit Premiums Paid to Carrier	USD $118,900
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

AGC0000179569

Policy instance

Insurance contract or identification number	AGC0000179569
Number of Individuals Covered	285
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $15,170
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to Carrier	USD $35,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

275518

Policy instance

Insurance contract or identification number	275518
Number of Individuals Covered	149
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $17,076
Total amount of fees paid to insurance company	USD $1,275
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $606,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05974846

Policy instance

Insurance contract or identification number	KM05974846
Number of Individuals Covered	396
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $10,454
Total amount of fees paid to insurance company	USD $534
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $53,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

99428551001

Policy instance

Insurance contract or identification number	99428551001
Number of Individuals Covered	488
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,786
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

275518

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10264940

Policy instance

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10264940

Policy instance

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

5974846

Policy instance

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )

Policy contract number

99428551001

Policy instance

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Company Name:	DENTAL DEPOT DSO, LLC
Employer identification number (EIN):	204886566
NAIC Classification:	621210
NAIC Description:	Offices of Dentists