401k Plan data: WASHINGTON DENTAL SERVICE PLAN plan

WASHINGTON DENTAL SERVICE PLAN 401k Plan overview

Plan Name	WASHINGTON DENTAL SERVICE PLAN
Plan identification number	504

WASHINGTON DENTAL SERVICE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

BAKER BOYER NATIONAL BANK TRUST 3-004866 has sponsored the creation of one or more 401k plans.

Company Name: BAKER BOYER NATIONAL BANK TRUST 3-004866

Employer identification number (EIN): 910135040

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WASHINGTON DENTAL SERVICE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
504 2015-01-01 DEIRDRE BEALEY
504 2015-01-01 AMANDA ANDERSON 2023-07-03
504 2014-01-01 DEIRDRE BEALEY
504 2013-01-01 BROOKE HERMAN
504 2012-01-01 MELISSA HAWES
504 2011-01-01 JENNIFER PEHA
504 2009-01-01 JENNIFER PEHA

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
504	2015-01-01	DEIRDRE BEALEY
504	2015-01-01	AMANDA ANDERSON	2023-07-03
504	2014-01-01	DEIRDRE BEALEY
504	2013-01-01	BROOKE HERMAN
504	2012-01-01	MELISSA HAWES
504	2011-01-01	JENNIFER PEHA
504	2009-01-01	JENNIFER PEHA

Plan Statistics for WASHINGTON DENTAL SERVICE PLAN

401k plan membership statisitcs for WASHINGTON DENTAL SERVICE PLAN

Measure Date Value
2015: WASHINGTON DENTAL SERVICE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 169
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 169
Number of employers contributing to the scheme 2015-01-01 0
2014: WASHINGTON DENTAL SERVICE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 172
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 172
2013: WASHINGTON DENTAL SERVICE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 169
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 160
Total of all active and inactive participants 2013-01-01 160
2012: WASHINGTON DENTAL SERVICE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 170
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 169
Total of all active and inactive participants 2012-01-01 169
2011: WASHINGTON DENTAL SERVICE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 170
Total of all active and inactive participants 2011-01-01 170
2009: WASHINGTON DENTAL SERVICE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 170
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 170
Total of all active and inactive participants 2009-01-01 170

Measure	Date	Value
2015: WASHINGTON DENTAL SERVICE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	169
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	169
Number of employers contributing to the scheme	2015-01-01	0
2014: WASHINGTON DENTAL SERVICE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	172
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	172
2013: WASHINGTON DENTAL SERVICE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	169
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	160
Total of all active and inactive participants	2013-01-01	160
2012: WASHINGTON DENTAL SERVICE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	170
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	169
Total of all active and inactive participants	2012-01-01	169
2011: WASHINGTON DENTAL SERVICE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	170
Total of all active and inactive participants	2011-01-01	170
2009: WASHINGTON DENTAL SERVICE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	170
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	170
Total of all active and inactive participants	2009-01-01	170

Form 5500 Responses for WASHINGTON DENTAL SERVICE PLAN

2015: WASHINGTON DENTAL SERVICE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	Yes
2015-01-01	This submission is the final filing	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: WASHINGTON DENTAL SERVICE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: WASHINGTON DENTAL SERVICE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: WASHINGTON DENTAL SERVICE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: WASHINGTON DENTAL SERVICE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: WASHINGTON DENTAL SERVICE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

311

Policy instance

Insurance contract or identification number	311
Number of Individuals Covered	165
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,814
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $2,814
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

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Company Name:	BAKER BOYER NATIONAL BANK TRUST 3-004866
Employer identification number (EIN):	910135040
NAIC Classification:	522110
NAIC Description:	Commercial Banking