401k Plan data: HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN plan

HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN 401k Plan overview

Plan Name	HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN
Plan identification number	502

HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

HALDEMAN HOMME HOLDINGS INC has sponsored the creation of one or more 401k plans.

Company Name: HALDEMAN HOMME HOLDINGS INC

Employer identification number (EIN): 410733913

NAIC Classification: 236200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2020-01-01 ANTHI MENZEL 2021-04-20
502 2020-01-01
502 2019-01-01 ANTHI MENZEL 2020-07-24

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2020-01-01	ANTHI MENZEL	2021-04-20
502	2020-01-01
502	2019-01-01	ANTHI MENZEL	2020-07-24

Plan Statistics for HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN

401k plan membership statisitcs for HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN

Measure Date Value
2020: HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 97
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 154
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 154
Number of employers contributing to the scheme 2020-01-01 0
2019: HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 97
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 97
Number of employers contributing to the scheme 2019-01-01 0

Measure	Date	Value
2020: HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	97
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	154
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	154
Number of employers contributing to the scheme	2020-01-01	0
2019: HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	97
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	97
Number of employers contributing to the scheme	2019-01-01	0

Form 5500 Responses for HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN

2020: HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	Yes
2020-01-01	This submission is the final filing	Yes
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2019: HALDEMAN HOMME HOLDINGS INC. DENTAL PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 )

Policy contract number

887531

Policy instance

Insurance contract or identification number	887531
Number of Individuals Covered	321
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $13,968
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $137,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,856
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 )

Policy contract number

887531

Policy instance

Insurance contract or identification number	887531
Number of Individuals Covered	195
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $9,207
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,138
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

HALDEMAN HOMME HOLDINGS INC. WELFARE PLAN [EIN = 843007083]

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Company Name:	HALDEMAN HOMME HOLDINGS INC
Employer identification number (EIN):	410733913
NAIC Classification:	236200