401k Plan data: THE TOTS TO TEENS PEDIATRIC DENTISTRY EMPLOYEE BENEFIT PLAN plan

THE TOTS TO TEENS PEDIATRIC DENTISTRY EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	THE TOTS TO TEENS PEDIATRIC DENTISTRY EMPLOYEE BENEFIT PLAN
Plan identification number	501

THE TOTS TO TEENS PEDIATRIC DENTISTRY EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

TOTS TO TEENS PEDIATRIC DENTISTRY, has sponsored the creation of one or more 401k plans.

Company Name: TOTS TO TEENS PEDIATRIC DENTISTRY,

Employer identification number (EIN): 271561225

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE TOTS TO TEENS PEDIATRIC DENTISTRY EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 JOANNA AYALA 2024-05-21
501 2022-01-01 JOANNA AYALA 2023-05-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-01-01	JOANNA AYALA	2024-05-21
501	2022-01-01	JOANNA AYALA	2023-05-10

Form 5500 Responses for THE TOTS TO TEENS PEDIATRIC DENTISTRY EMPLOYEE BENEFIT PLAN

2023: THE TOTS TO TEENS PEDIATRIC DENTISTRY EMPLOYEE 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: THE TOTS TO TEENS PEDIATRIC DENTISTRY EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	First time form 5500 has been submitted	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

01L7536

Policy instance

Insurance contract or identification number	01L7536
Number of Individuals Covered	220
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $25,581
Total amount of fees paid to insurance company	USD $1,123
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $563,007
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

1122069

Policy instance

Insurance contract or identification number	1122069
Number of Individuals Covered	105
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $3,943
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,421
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

01L7536

Policy instance

Insurance contract or identification number	01L7536
Number of Individuals Covered	153
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $18,371
Total amount of fees paid to insurance company	USD $363
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $389,685
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	TOTS TO TEENS PEDIATRIC DENTISTRY,
Employer identification number (EIN):	271561225
NAIC Classification:	621210
NAIC Description:	Offices of Dentists