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DELTA DENTAL INSURANCE 401k Plan overview

Plan NameDELTA DENTAL INSURANCE
Plan identification number 503

DELTA DENTAL INSURANCE Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Dental

401k Sponsoring company profile

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

Company Name:CUBRC INC
Employer identification number (EIN):222505934
NAIC Classification:541700

Additional information about CUBRC INC

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1983-12-07
Company Identification Number: 862775
Legal Registered Office Address: 4455 GENESEE STREET
SUITE 106
BUFFALO
United States of America (USA)
14225

More information about CUBRC INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DELTA DENTAL INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032017-01-01TRACY GERTZ TRACY GERTZ2018-07-19
5032016-01-01TRACY GERTZ
5032015-01-01TRACY GERTZ
5032014-01-01TRACY GERTZ
5032013-01-01TRACY GERTZ TRACY GERTZ2014-10-03
5032012-01-01TRACY GERTZ
5032011-01-01TRACY GERTZ

Plan Statistics for DELTA DENTAL INSURANCE

401k plan membership statisitcs for DELTA DENTAL INSURANCE

Measure Date Value
2017: DELTA DENTAL INSURANCE 2017 401k membership
Total participants, beginning-of-year2017-01-0199
Total number of active participants reported on line 7a of the Form 55002017-01-0197
Total of all active and inactive participants2017-01-0197
Total participants2017-01-0197
2016: DELTA DENTAL INSURANCE 2016 401k membership
Total participants, beginning-of-year2016-01-0189
Total number of active participants reported on line 7a of the Form 55002016-01-0199
Total of all active and inactive participants2016-01-0199
Total participants2016-01-0199
2015: DELTA DENTAL INSURANCE 2015 401k membership
Total participants, beginning-of-year2015-01-0186
Total number of active participants reported on line 7a of the Form 55002015-01-0189
Total of all active and inactive participants2015-01-0189
Total participants2015-01-0189
2014: DELTA DENTAL INSURANCE 2014 401k membership
Total participants, beginning-of-year2014-01-01118
Total number of active participants reported on line 7a of the Form 55002014-01-0186
Number of retired or separated participants receiving benefits2014-01-011
Total of all active and inactive participants2014-01-0187
Total participants2014-01-0187
2013: DELTA DENTAL INSURANCE 2013 401k membership
Total participants, beginning-of-year2013-01-01109
Total number of active participants reported on line 7a of the Form 55002013-01-01119
Number of retired or separated participants receiving benefits2013-01-011
Total of all active and inactive participants2013-01-01120
Total participants2013-01-01120
2012: DELTA DENTAL INSURANCE 2012 401k membership
Total participants, beginning-of-year2012-01-01110
Total number of active participants reported on line 7a of the Form 55002012-01-01107
Number of retired or separated participants receiving benefits2012-01-012
Total of all active and inactive participants2012-01-01109
Total participants2012-01-01109
2011: DELTA DENTAL INSURANCE 2011 401k membership
Total participants, beginning-of-year2011-01-01117
Total number of active participants reported on line 7a of the Form 55002011-01-01107
Number of retired or separated participants receiving benefits2011-01-014
Total of all active and inactive participants2011-01-01111
Total participants2011-01-01111

Form 5500 Responses for DELTA DENTAL INSURANCE

2017: DELTA DENTAL INSURANCE 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01First time form 5500 has been submittedYes
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: DELTA DENTAL INSURANCE 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: DELTA DENTAL INSURANCE 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01First time form 5500 has been submittedYes
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: DELTA DENTAL INSURANCE 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01First time form 5500 has been submittedYes
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: DELTA DENTAL INSURANCE 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: DELTA DENTAL INSURANCE 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: DELTA DENTAL INSURANCE 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )
Policy contract number05219
Policy instance 1
Insurance contract or identification number05219
Number of Individuals Covered97
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $89,847
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )
Policy contract number05219
Policy instance 1
Insurance contract or identification number05219
Number of Individuals Covered89
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $82,858
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )
Policy contract number05219
Policy instance 1
Insurance contract or identification number05219
Number of Individuals Covered86
Insurance policy start date2014-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $86,371
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )
Policy contract number05219
Policy instance 1
Insurance contract or identification number05219
Number of Individuals Covered119
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $93,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )
Policy contract number05219
Policy instance 1
Insurance contract or identification number05219
Number of Individuals Covered107
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )
Policy contract number05219
Policy instance 1
Insurance contract or identification number05219
Number of Individuals Covered109
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,284
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $86,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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