401k Plan data: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST plan

SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 401k Plan overview

Plan Name	SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST
Plan identification number	501

SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance

401k Sponsoring company profile

SOUTH CAROLINA DENTAL ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name: SOUTH CAROLINA DENTAL ASSOCIATION

Employer identification number (EIN): 816916597

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-02-01
501 2021-02-01
501 2020-02-01
501 2019-02-01
501 2018-02-01 JOHN (PHIL) LATHAM
501 2017-02-01 JOHN (PHIL) LATHAM

Plan Statistics for SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST

401k plan membership statisitcs for SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST

Measure Date Value
2022: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2022 401k membership
Total participants, beginning-of-year 2022-02-01 1,060
Total number of active participants reported on line 7a of the Form 5500 2022-02-01 948
Number of retired or separated participants receiving benefits 2022-02-01 1
Number of other retired or separated participants entitled to future benefits 2022-02-01 0
Total of all active and inactive participants 2022-02-01 949
2021: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2021 401k membership
Total participants, beginning-of-year 2021-02-01 1,108
Total number of active participants reported on line 7a of the Form 5500 2021-02-01 1,057
Number of retired or separated participants receiving benefits 2021-02-01 3
Number of other retired or separated participants entitled to future benefits 2021-02-01 0
Total of all active and inactive participants 2021-02-01 1,060
2020: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2020 401k membership
Total participants, beginning-of-year 2020-02-01 1,111
Total number of active participants reported on line 7a of the Form 5500 2020-02-01 1,101
Number of retired or separated participants receiving benefits 2020-02-01 7
Number of other retired or separated participants entitled to future benefits 2020-02-01 0
Total of all active and inactive participants 2020-02-01 1,108
2019: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2019 401k membership
Total participants, beginning-of-year 2019-02-01 1,154
Total number of active participants reported on line 7a of the Form 5500 2019-02-01 1,104
Number of retired or separated participants receiving benefits 2019-02-01 7
Number of other retired or separated participants entitled to future benefits 2019-02-01 0
Total of all active and inactive participants 2019-02-01 1,111
2018: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2018 401k membership
Total participants, beginning-of-year 2018-02-01 1,205
Total number of active participants reported on line 7a of the Form 5500 2018-02-01 1,144
Number of retired or separated participants receiving benefits 2018-02-01 10
Number of other retired or separated participants entitled to future benefits 2018-02-01 0
Total of all active and inactive participants 2018-02-01 1,154
2017: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2017 401k membership
Total participants, beginning-of-year 2017-02-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-02-01 1,191
Number of retired or separated participants receiving benefits 2017-02-01 14
Number of other retired or separated participants entitled to future benefits 2017-02-01 0
Total of all active and inactive participants 2017-02-01 1,205

Measure	Date	Value
2022: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2022 401k membership
Total participants, beginning-of-year	2022-02-01	1,060
Total number of active participants reported on line 7a of the Form 5500	2022-02-01	948
Number of retired or separated participants receiving benefits	2022-02-01	1
Number of other retired or separated participants entitled to future benefits	2022-02-01	0
Total of all active and inactive participants	2022-02-01	949
2021: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2021 401k membership
Total participants, beginning-of-year	2021-02-01	1,108
Total number of active participants reported on line 7a of the Form 5500	2021-02-01	1,057
Number of retired or separated participants receiving benefits	2021-02-01	3
Number of other retired or separated participants entitled to future benefits	2021-02-01	0
Total of all active and inactive participants	2021-02-01	1,060
2020: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2020 401k membership
Total participants, beginning-of-year	2020-02-01	1,111
Total number of active participants reported on line 7a of the Form 5500	2020-02-01	1,101
Number of retired or separated participants receiving benefits	2020-02-01	7
Number of other retired or separated participants entitled to future benefits	2020-02-01	0
Total of all active and inactive participants	2020-02-01	1,108
2019: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2019 401k membership
Total participants, beginning-of-year	2019-02-01	1,154
Total number of active participants reported on line 7a of the Form 5500	2019-02-01	1,104
Number of retired or separated participants receiving benefits	2019-02-01	7
Number of other retired or separated participants entitled to future benefits	2019-02-01	0
Total of all active and inactive participants	2019-02-01	1,111
2018: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2018 401k membership
Total participants, beginning-of-year	2018-02-01	1,205
Total number of active participants reported on line 7a of the Form 5500	2018-02-01	1,144
Number of retired or separated participants receiving benefits	2018-02-01	10
Number of other retired or separated participants entitled to future benefits	2018-02-01	0
Total of all active and inactive participants	2018-02-01	1,154
2017: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2017 401k membership
Total participants, beginning-of-year	2017-02-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-02-01	1,191
Number of retired or separated participants receiving benefits	2017-02-01	14
Number of other retired or separated participants entitled to future benefits	2017-02-01	0
Total of all active and inactive participants	2017-02-01	1,205

Financial Data on SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST

Measure	Date	Value
2023 : SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-01-31	$143,333
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-01-31	$330,743
Total income from all sources (including contributions)	2023-01-31	$11,785,870
Total loss/gain on sale of assets	2023-01-31	$0
Total of all expenses incurred	2023-01-31	$11,783,283
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-01-31	$11,755,870
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-01-31	$11,785,870
Value of total assets at end of year	2023-01-31	$177,236
Value of total assets at beginning of year	2023-01-31	$362,059
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-01-31	$27,413
Total interest from all sources	2023-01-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2023-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-01-31	No
Administrative expenses professional fees incurred	2023-01-31	$13,440
Was this plan covered by a fidelity bond	2023-01-31	Yes
Value of fidelity bond cover	2023-01-31	$500,000
If this is an individual account plan, was there a blackout period	2023-01-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-01-31	No
Contributions received from participants	2023-01-31	$35,033
Participant contributions at end of year	2023-01-31	$1,406
Participant contributions at beginning of year	2023-01-31	$2,992
Value of other receiveables (less allowance for doubtful accounts) at end of year	2023-01-31	$6,142
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2023-01-31	$55
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2023-01-31	$88,291
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2023-01-31	$264,471
Administrative expenses (other) incurred	2023-01-31	$13,973
Liabilities. Value of operating payables at end of year	2023-01-31	$625
Liabilities. Value of operating payables at beginning of year	2023-01-31	$1,219
Total non interest bearing cash at end of year	2023-01-31	$141,245
Total non interest bearing cash at beginning of year	2023-01-31	$329,216
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-01-31	No
Value of net income/loss	2023-01-31	$2,587
Value of net assets at end of year (total assets less liabilities)	2023-01-31	$33,903
Value of net assets at beginning of year (total assets less liabilities)	2023-01-31	$31,316
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-01-31	No
Were any leases to which the plan was party in default or uncollectible	2023-01-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-01-31	No
Was there a failure to transmit to the plan any participant contributions	2023-01-31	No
Has the plan failed to provide any benefit when due under the plan	2023-01-31	No
Contributions received in cash from employer	2023-01-31	$11,750,837
Employer contributions (assets) at end of year	2023-01-31	$28,443
Employer contributions (assets) at beginning of year	2023-01-31	$29,796
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-01-31	$11,755,870
Liabilities. Value of benefit claims payable at end of year	2023-01-31	$54,417
Liabilities. Value of benefit claims payable at beginning of year	2023-01-31	$65,053
Did the plan have assets held for investment	2023-01-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-01-31	No
Opinion of an independent qualified public accountant for this plan	2023-01-31	Unqualified
Accountancy firm name	2023-01-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2023-01-31	410746749
2022 : SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-01-31	$330,743
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-01-31	$126,795
Total income from all sources (including contributions)	2022-01-31	$11,725,016
Total loss/gain on sale of assets	2022-01-31	$0
Total of all expenses incurred	2022-01-31	$11,719,461
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-01-31	$11,692,922
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-01-31	$11,725,016
Value of total assets at end of year	2022-01-31	$362,059
Value of total assets at beginning of year	2022-01-31	$152,556
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-01-31	$26,539
Total interest from all sources	2022-01-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2022-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-01-31	No
Administrative expenses professional fees incurred	2022-01-31	$12,180
Was this plan covered by a fidelity bond	2022-01-31	Yes
Value of fidelity bond cover	2022-01-31	$500,000
If this is an individual account plan, was there a blackout period	2022-01-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-01-31	No
Contributions received from participants	2022-01-31	$85,688
Participant contributions at end of year	2022-01-31	$2,992
Participant contributions at beginning of year	2022-01-31	$4,101
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-01-31	$55
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-01-31	$9,934
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-01-31	$264,471
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-01-31	$63,595
Administrative expenses (other) incurred	2022-01-31	$14,359
Liabilities. Value of operating payables at end of year	2022-01-31	$1,219
Liabilities. Value of operating payables at beginning of year	2022-01-31	$1,182
Total non interest bearing cash at end of year	2022-01-31	$329,216
Total non interest bearing cash at beginning of year	2022-01-31	$107,173
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-01-31	No
Value of net income/loss	2022-01-31	$5,555
Value of net assets at end of year (total assets less liabilities)	2022-01-31	$31,316
Value of net assets at beginning of year (total assets less liabilities)	2022-01-31	$25,761
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-01-31	No
Were any leases to which the plan was party in default or uncollectible	2022-01-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2022-01-31	$11,692,922
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-01-31	No
Was there a failure to transmit to the plan any participant contributions	2022-01-31	No
Has the plan failed to provide any benefit when due under the plan	2022-01-31	No
Contributions received in cash from employer	2022-01-31	$11,639,328
Employer contributions (assets) at end of year	2022-01-31	$29,796
Employer contributions (assets) at beginning of year	2022-01-31	$31,348
Liabilities. Value of benefit claims payable at end of year	2022-01-31	$65,053
Liabilities. Value of benefit claims payable at beginning of year	2022-01-31	$62,018
Did the plan have assets held for investment	2022-01-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-01-31	No
Opinion of an independent qualified public accountant for this plan	2022-01-31	Unqualified
Accountancy firm name	2022-01-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2022-01-31	410746749
2021 : SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-01-31	$126,795
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-01-31	$377,400
Total income from all sources (including contributions)	2021-01-31	$12,132,004
Total loss/gain on sale of assets	2021-01-31	$0
Total of all expenses incurred	2021-01-31	$12,161,166
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-01-31	$12,134,117
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-01-31	$12,132,004
Value of total assets at end of year	2021-01-31	$152,556
Value of total assets at beginning of year	2021-01-31	$432,323
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-01-31	$27,049
Total interest from all sources	2021-01-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2021-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-01-31	No
Administrative expenses professional fees incurred	2021-01-31	$12,075
Was this plan covered by a fidelity bond	2021-01-31	Yes
Value of fidelity bond cover	2021-01-31	$500,000
If this is an individual account plan, was there a blackout period	2021-01-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-01-31	No
Contributions received from participants	2021-01-31	$100,795
Participant contributions at end of year	2021-01-31	$4,101
Participant contributions at beginning of year	2021-01-31	$4,534
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-01-31	$9,934
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-01-31	$16,371
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-01-31	$63,595
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-01-31	$311,049
Administrative expenses (other) incurred	2021-01-31	$14,974
Liabilities. Value of operating payables at end of year	2021-01-31	$1,182
Liabilities. Value of operating payables at beginning of year	2021-01-31	$573
Total non interest bearing cash at end of year	2021-01-31	$107,173
Total non interest bearing cash at beginning of year	2021-01-31	$373,975
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-01-31	No
Value of net income/loss	2021-01-31	$-29,162
Value of net assets at end of year (total assets less liabilities)	2021-01-31	$25,761
Value of net assets at beginning of year (total assets less liabilities)	2021-01-31	$54,923
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-01-31	No
Were any leases to which the plan was party in default or uncollectible	2021-01-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2021-01-31	$12,134,117
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-01-31	No
Was there a failure to transmit to the plan any participant contributions	2021-01-31	No
Has the plan failed to provide any benefit when due under the plan	2021-01-31	No
Contributions received in cash from employer	2021-01-31	$12,031,209
Employer contributions (assets) at end of year	2021-01-31	$31,348
Employer contributions (assets) at beginning of year	2021-01-31	$37,443
Liabilities. Value of benefit claims payable at end of year	2021-01-31	$62,018
Liabilities. Value of benefit claims payable at beginning of year	2021-01-31	$65,778
Did the plan have assets held for investment	2021-01-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-01-31	No
Opinion of an independent qualified public accountant for this plan	2021-01-31	Unqualified
Accountancy firm name	2021-01-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2021-01-31	410746749
2020 : SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-01-31	$377,400
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-01-31	$397,541
Total income from all sources (including contributions)	2020-01-31	$12,444,735
Total loss/gain on sale of assets	2020-01-31	$0
Total of all expenses incurred	2020-01-31	$12,410,247
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-01-31	$12,369,738
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-01-31	$12,444,735
Value of total assets at end of year	2020-01-31	$432,323
Value of total assets at beginning of year	2020-01-31	$417,976
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-01-31	$40,509
Total interest from all sources	2020-01-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2020-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-01-31	No
Administrative expenses professional fees incurred	2020-01-31	$25,545
Was this plan covered by a fidelity bond	2020-01-31	Yes
Value of fidelity bond cover	2020-01-31	$500,000
If this is an individual account plan, was there a blackout period	2020-01-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-01-31	No
Contributions received from participants	2020-01-31	$90,831
Participant contributions at end of year	2020-01-31	$4,534
Participant contributions at beginning of year	2020-01-31	$8,682
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-01-31	$16,371
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-01-31	$20,541
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-01-31	$311,049
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-01-31	$266,226
Administrative expenses (other) incurred	2020-01-31	$14,964
Liabilities. Value of operating payables at end of year	2020-01-31	$573
Liabilities. Value of operating payables at beginning of year	2020-01-31	$565
Total non interest bearing cash at end of year	2020-01-31	$373,975
Total non interest bearing cash at beginning of year	2020-01-31	$316,537
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-01-31	No
Value of net income/loss	2020-01-31	$34,488
Value of net assets at end of year (total assets less liabilities)	2020-01-31	$54,923
Value of net assets at beginning of year (total assets less liabilities)	2020-01-31	$20,435
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-01-31	No
Were any leases to which the plan was party in default or uncollectible	2020-01-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2020-01-31	$12,369,738
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-01-31	No
Was there a failure to transmit to the plan any participant contributions	2020-01-31	No
Has the plan failed to provide any benefit when due under the plan	2020-01-31	No
Contributions received in cash from employer	2020-01-31	$12,353,904
Employer contributions (assets) at end of year	2020-01-31	$37,443
Employer contributions (assets) at beginning of year	2020-01-31	$72,216
Liabilities. Value of benefit claims payable at end of year	2020-01-31	$65,778
Liabilities. Value of benefit claims payable at beginning of year	2020-01-31	$130,750
Did the plan have assets held for investment	2020-01-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-01-31	No
Opinion of an independent qualified public accountant for this plan	2020-01-31	Unqualified
Accountancy firm name	2020-01-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2020-01-31	410746749
2019 : SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-01-31	$397,541
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-01-31	$342,811
Total income from all sources (including contributions)	2019-01-31	$12,370,055
Total loss/gain on sale of assets	2019-01-31	$0
Total of all expenses incurred	2019-01-31	$12,361,234
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-01-31	$12,343,215
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-01-31	$12,370,055
Value of total assets at end of year	2019-01-31	$417,976
Value of total assets at beginning of year	2019-01-31	$354,425
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-01-31	$18,019
Total interest from all sources	2019-01-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2019-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-01-31	No
Was this plan covered by a fidelity bond	2019-01-31	Yes
Value of fidelity bond cover	2019-01-31	$500,000
If this is an individual account plan, was there a blackout period	2019-01-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-01-31	No
Contributions received from participants	2019-01-31	$130,447
Participant contributions at end of year	2019-01-31	$8,682
Participant contributions at beginning of year	2019-01-31	$15,623
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-01-31	$20,541
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-01-31	$30,662
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-01-31	$266,226
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-01-31	$81,834
Administrative expenses (other) incurred	2019-01-31	$18,019
Liabilities. Value of operating payables at end of year	2019-01-31	$565
Liabilities. Value of operating payables at beginning of year	2019-01-31	$571
Total non interest bearing cash at end of year	2019-01-31	$316,537
Total non interest bearing cash at beginning of year	2019-01-31	$261,059
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-01-31	No
Value of net income/loss	2019-01-31	$8,821
Value of net assets at end of year (total assets less liabilities)	2019-01-31	$20,435
Value of net assets at beginning of year (total assets less liabilities)	2019-01-31	$11,614
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-01-31	No
Were any leases to which the plan was party in default or uncollectible	2019-01-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2019-01-31	$12,343,215
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-01-31	No
Was there a failure to transmit to the plan any participant contributions	2019-01-31	No
Has the plan failed to provide any benefit when due under the plan	2019-01-31	No
Contributions received in cash from employer	2019-01-31	$12,239,608
Employer contributions (assets) at end of year	2019-01-31	$72,216
Employer contributions (assets) at beginning of year	2019-01-31	$47,081
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-01-31	No
Liabilities. Value of benefit claims payable at end of year	2019-01-31	$130,750
Liabilities. Value of benefit claims payable at beginning of year	2019-01-31	$260,406
Did the plan have assets held for investment	2019-01-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-01-31	No
Opinion of an independent qualified public accountant for this plan	2019-01-31	Unqualified
Accountancy firm name	2019-01-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2019-01-31	410746749
2018 : SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-01-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-01-31	$342,811
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-01-31	$0
Total income from all sources (including contributions)	2018-01-31	$12,196,867
Total loss/gain on sale of assets	2018-01-31	$0
Total of all expenses incurred	2018-01-31	$12,185,253
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-01-31	$12,179,867
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-01-31	$12,196,867
Value of total assets at end of year	2018-01-31	$354,425
Value of total assets at beginning of year	2018-01-31	$0
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-01-31	$5,386
Total interest from all sources	2018-01-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2018-01-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-01-31	No
Was this plan covered by a fidelity bond	2018-01-31	Yes
Value of fidelity bond cover	2018-01-31	$500,000
If this is an individual account plan, was there a blackout period	2018-01-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-01-31	No
Contributions received from participants	2018-01-31	$106,961
Participant contributions at end of year	2018-01-31	$15,623
Participant contributions at beginning of year	2018-01-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-01-31	$30,662
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-01-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-01-31	$81,834
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-01-31	$0
Administrative expenses (other) incurred	2018-01-31	$5,386
Liabilities. Value of operating payables at end of year	2018-01-31	$571
Liabilities. Value of operating payables at beginning of year	2018-01-31	$0
Total non interest bearing cash at end of year	2018-01-31	$261,059
Total non interest bearing cash at beginning of year	2018-01-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-01-31	No
Value of net income/loss	2018-01-31	$11,614
Value of net assets at end of year (total assets less liabilities)	2018-01-31	$11,614
Value of net assets at beginning of year (total assets less liabilities)	2018-01-31	$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-01-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-01-31	No
Were any leases to which the plan was party in default or uncollectible	2018-01-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2018-01-31	$12,179,867
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-01-31	No
Was there a failure to transmit to the plan any participant contributions	2018-01-31	No
Has the plan failed to provide any benefit when due under the plan	2018-01-31	No
Contributions received in cash from employer	2018-01-31	$12,089,906
Employer contributions (assets) at end of year	2018-01-31	$47,081
Employer contributions (assets) at beginning of year	2018-01-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-01-31	No
Liabilities. Value of benefit claims payable at end of year	2018-01-31	$260,406
Liabilities. Value of benefit claims payable at beginning of year	2018-01-31	$0
Did the plan have assets held for investment	2018-01-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-01-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-01-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-01-31	No
Opinion of an independent qualified public accountant for this plan	2018-01-31	Unqualified
Accountancy firm name	2018-01-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2018-01-31	410745749

Form 5500 Responses for SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST

2022: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2022 form 5500 responses
2022-02-01	Type of plan entity	Mulitple employer plan
2022-02-01	Submission has been amended	No
2022-02-01	This submission is the final filing	No
2022-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-02-01	Plan is a collectively bargained plan	No
2022-02-01	Plan funding arrangement – Insurance	Yes
2022-02-01	Plan funding arrangement – Trust	Yes
2022-02-01	Plan benefit arrangement – Insurance	Yes
2022-02-01	Plan benefit arrangement - Trust	Yes
2021: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2021 form 5500 responses
2021-02-01	Type of plan entity	Mulitple employer plan
2021-02-01	Submission has been amended	No
2021-02-01	This submission is the final filing	No
2021-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-02-01	Plan is a collectively bargained plan	No
2021-02-01	Plan funding arrangement – Insurance	Yes
2021-02-01	Plan funding arrangement – Trust	Yes
2021-02-01	Plan benefit arrangement – Insurance	Yes
2021-02-01	Plan benefit arrangement - Trust	Yes
2020: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2020 form 5500 responses
2020-02-01	Type of plan entity	Mulitple employer plan
2020-02-01	Submission has been amended	No
2020-02-01	This submission is the final filing	No
2020-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-02-01	Plan is a collectively bargained plan	No
2020-02-01	Plan funding arrangement – Insurance	Yes
2020-02-01	Plan funding arrangement – Trust	Yes
2020-02-01	Plan benefit arrangement – Insurance	Yes
2020-02-01	Plan benefit arrangement - Trust	Yes
2019: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2019 form 5500 responses
2019-02-01	Type of plan entity	Mulitple employer plan
2019-02-01	Submission has been amended	No
2019-02-01	This submission is the final filing	No
2019-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-02-01	Plan is a collectively bargained plan	No
2019-02-01	Plan funding arrangement – Insurance	Yes
2019-02-01	Plan funding arrangement – Trust	Yes
2019-02-01	Plan benefit arrangement – Insurance	Yes
2019-02-01	Plan benefit arrangement - Trust	Yes
2018: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2018 form 5500 responses
2018-02-01	Type of plan entity	Mulitple employer plan
2018-02-01	Submission has been amended	No
2018-02-01	This submission is the final filing	No
2018-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-02-01	Plan is a collectively bargained plan	No
2018-02-01	Plan funding arrangement – Insurance	Yes
2018-02-01	Plan funding arrangement – Trust	Yes
2018-02-01	Plan benefit arrangement – Insurance	Yes
2018-02-01	Plan benefit arrangement - Trust	Yes
2017: SOUTH CAROLINA DENTAL ASSOCIATION GROUP INSURANCE TRUST 2017 form 5500 responses
2017-02-01	Type of plan entity	Mulitple employer plan
2017-02-01	First time form 5500 has been submitted	Yes
2017-02-01	Submission has been amended	No
2017-02-01	This submission is the final filing	No
2017-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-02-01	Plan is a collectively bargained plan	No
2017-02-01	Plan funding arrangement – Insurance	Yes
2017-02-01	Plan funding arrangement – Trust	Yes
2017-02-01	Plan benefit arrangement – Insurance	Yes
2017-02-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

26-56930

Policy instance

Insurance contract or identification number	26-56930
Number of Individuals Covered	113
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
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 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
Dental Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

26-56930

Policy instance

Insurance contract or identification number	26-56930
Number of Individuals Covered	202
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
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 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
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $15,611
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

3852656930

Policy instance

Insurance contract or identification number	3852656930
Number of Individuals Covered	995
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
Total amount of commissions paid to insurance broker	USD $4,991
Total amount of fees paid to insurance company	USD $0
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
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 Carrier	USD $60,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,023
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

26-56930

Policy instance

Insurance contract or identification number	26-56930
Number of Individuals Covered	948
Insurance policy start date	2022-02-01
Insurance policy end date	2023-01-31
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 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	Yes
Dental 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
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

26-56930

Policy instance

Insurance contract or identification number	26-56930
Number of Individuals Covered	220
Insurance policy start date	2021-02-01
Insurance policy end date	2022-01-31
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 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
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $16,838
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

3852656930

Policy instance

Insurance contract or identification number	3852656930
Number of Individuals Covered	1078
Insurance policy start date	2021-02-01
Insurance policy end date	2022-01-31
Total amount of commissions paid to insurance broker	USD $5,184
Total amount of fees paid to insurance company	USD $0
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
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 Carrier	USD $63,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,177
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

26-56930

Policy instance

Insurance contract or identification number	26-56930
Number of Individuals Covered	1057
Insurance policy start date	2021-02-01
Insurance policy end date	2022-01-31
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 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	Yes
Dental 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
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

3852656930

Policy instance

Insurance contract or identification number	3852656930
Number of Individuals Covered	1054
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
Total amount of commissions paid to insurance broker	USD $5,980
Total amount of fees paid to insurance company	USD $0
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
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 Carrier	USD $76,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,805
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

26-56930

Policy instance

Insurance contract or identification number	26-56930
Number of Individuals Covered	1101
Insurance policy start date	2020-02-01
Insurance policy end date	2021-01-31
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 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	Yes
Dental 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

3852656930

Policy instance

Insurance contract or identification number	3852656930
Number of Individuals Covered	1089
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
Total amount of commissions paid to insurance broker	USD $12,552
Total amount of fees paid to insurance company	USD $0
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
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 Carrier	USD $60,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,159
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

26-56930

Policy instance

Insurance contract or identification number	26-56930
Number of Individuals Covered	1104
Insurance policy start date	2019-02-01
Insurance policy end date	2020-01-31
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 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	Yes
Dental 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

3852656930

Policy instance

Insurance contract or identification number	3852656930
Number of Individuals Covered	1140
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
Total amount of commissions paid to insurance broker	USD $5,602
Total amount of fees paid to insurance company	USD $0
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
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 Carrier	USD $70,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,512
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

26-56930

Policy instance

Insurance contract or identification number	26-56930
Number of Individuals Covered	1144
Insurance policy start date	2018-02-01
Insurance policy end date	2019-01-31
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 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	Yes
Dental 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )

Policy contract number

3852656930

Policy instance

Insurance contract or identification number	3852656930
Number of Individuals Covered	1140
Insurance policy start date	2017-02-01
Insurance policy end date	2018-01-31
Total amount of commissions paid to insurance broker	USD $6,156
Total amount of fees paid to insurance company	USD $0
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
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	AD&D
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 Carrier	USD $76,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,812
Insurance broker organization code?	3
Insurance broker name	BCBS OF SOUTH CAROLINA

BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 )

Policy contract number

26-56930

Policy instance

Insurance contract or identification number	26-56930
Number of Individuals Covered	1191
Insurance policy start date	2017-02-01
Insurance policy end date	2018-01-31
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 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	Yes
Dental 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SOUTH CAROLINA DENTAL ASSOCIATION
Employer identification number (EIN):	816916597
NAIC Classification:	621210
NAIC Description:	Offices of Dentists