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| Plan Name | GROUP LIFE AND AD7D |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | UNDERBITE MANAGEMENT |
| Employer identification number (EIN): | 831170298 |
| NAIC Classification: | 621111 |
| NAIC Description: | Offices of Physicians (except Mental Health Specialists) |
Additional information about UNDERBITE MANAGEMENT
| Jurisdiction of Incorporation: | New York Department of State |
| Incorporation Date: | 2018-06-06 |
| Company Identification Number: | 5354519 |
| Legal Registered Office Address: |
230 WEST 41ST STREET 2ND FLOOR NEW YORK United States of America (USA) 10036 |
More information about UNDERBITE MANAGEMENT
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2022-11-01 | ESIDA DESTANI | 2024-06-18 | ||
| 501 | 2021-11-01 | ESIDA DESTANI | 2023-07-11 | ||
| 501 | 2020-11-01 | ESIDA DESTANI | 2022-05-17 |
| Measure | Date | Value |
|---|---|---|
| 2022: GROUP LIFE AND AD7D 2022 401k membership | ||
| Total participants, beginning-of-year | 2022-11-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-11-01 | 130 |
| Number of retired or separated participants receiving benefits | 2022-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-11-01 | 0 |
| Total of all active and inactive participants | 2022-11-01 | 130 |
| Number of employers contributing to the scheme | 2022-11-01 | 0 |
| 2021: GROUP LIFE AND AD7D 2021 401k membership | ||
| Total participants, beginning-of-year | 2021-11-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 130 |
| Number of retired or separated participants receiving benefits | 2021-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-11-01 | 0 |
| Total of all active and inactive participants | 2021-11-01 | 130 |
| Number of employers contributing to the scheme | 2021-11-01 | 0 |
| 2020: GROUP LIFE AND AD7D 2020 401k membership | ||
| Total participants, beginning-of-year | 2020-11-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-11-01 | 103 |
| Number of retired or separated participants receiving benefits | 2020-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-11-01 | 0 |
| Total of all active and inactive participants | 2020-11-01 | 103 |
| Number of employers contributing to the scheme | 2020-11-01 | 0 |
| 2022: GROUP LIFE AND AD7D 2022 form 5500 responses | ||
|---|---|---|
| 2022-11-01 | Type of plan entity | Single employer plan |
| 2022-11-01 | Plan funding arrangement – Insurance | Yes |
| 2022-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: GROUP LIFE AND AD7D 2021 form 5500 responses | ||
| 2021-11-01 | Type of plan entity | Single employer plan |
| 2021-11-01 | Plan funding arrangement – Insurance | Yes |
| 2021-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: GROUP LIFE AND AD7D 2020 form 5500 responses | ||
| 2020-11-01 | Type of plan entity | Single employer plan |
| 2020-11-01 | First time form 5500 has been submitted | Yes |
| 2020-11-01 | Plan funding arrangement – Insurance | Yes |
| 2020-11-01 | Plan benefit arrangement – Insurance | Yes |
| ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 ) | |
| Policy contract number | 300365 |
| Policy instance | 1 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 300365 |
| Policy instance | 2 |
| ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 ) | |
| Policy contract number | 300365 |
| Policy instance | 1 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 300365 |
| Policy instance | 2 |
| ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 ) | |
| Policy contract number | 300365 |
| Policy instance | 1 |
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) | |
| Policy contract number | 300365 |
| Policy instance | 2 |
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