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| Plan Name | JEFFREY SULITZER D.M.D |
| Plan identification number | 503 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | JEFFREY SULITZER D.M.D |
| Employer identification number (EIN): | 823344662 |
| NAIC Classification: | 621210 |
| NAIC Description: | Offices of Dentists |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 503 | 2020-01-01 | EDNA BECHARA | 2021-10-14 | ||
| 503 | 2020-01-01 | EDNA BECHARA | 2022-08-15 |
| Measure | Date | Value |
|---|---|---|
| 2020: JEFFREY SULITZER D.M.D 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-01-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 32 |
| 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 | 3 |
| Total of all active and inactive participants | 2020-01-01 | 35 |
| 2020: JEFFREY SULITZER D.M.D 2020 form 5500 responses | ||
|---|---|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | First time form 5500 has been submitted | Yes |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 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 funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) | |
| Policy contract number | 0143533 |
| Policy instance | 1 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) | |
| Policy contract number | GD3-890-LF0261 |
| Policy instance | 2 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) | |
| Policy contract number | GF3-890-LF0261 |
| Policy instance | 3 |
| LIBERTY LIFE ASSURANCE COMPANY OF BOSTON (National Association of Insurance Commissioners NAIC id number: 65315 ) | |
| Policy contract number | SA3-890-LF0261 |
| Policy instance | 4 |
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