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| Plan Name | DENTAL HMO |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CALIFORNIA PAYROLL GROUP |
| Employer identification number (EIN): | 462561662 |
| NAIC Classification: | 561110 |
| NAIC Description: | Office Administrative Services |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2018-01-01 | ||||
| 502 | 2017-01-01 | NICOLE WHITE | NICOLE WHITE | 2018-06-27 |
| Measure | Date | Value |
|---|---|---|
| 2018: DENTAL HMO 2018 401k membership | ||
| Total participants, beginning-of-year | 2018-01-01 | 231 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 280 |
| Total of all active and inactive participants | 2018-01-01 | 280 |
| Total participants | 2018-01-01 | 280 |
| 2017: DENTAL HMO 2017 401k membership | ||
| Total participants, beginning-of-year | 2017-01-01 | 225 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 330 |
| Total of all active and inactive participants | 2017-01-01 | 330 |
| Total participants | 2017-01-01 | 330 |
| 2018: DENTAL HMO 2018 form 5500 responses | ||
|---|---|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | First time form 5500 has been submitted | Yes |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: DENTAL HMO 2017 form 5500 responses | ||
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) | |
| Policy contract number | 5927263 |
| Policy instance | 1 |
| SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 ) | |
| Policy contract number | KM05927263 |
| Policy instance | 1 |
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