401k Plan data: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN plan

MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN 401k Plan overview

Plan Name	MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN
Plan identification number	509

MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

MAINE CENTER FOR CANCER MEDICINE & BLOOD DISORDERS, P.A. D/B/A has sponsored the creation of one or more 401k plans.

Company Name: MAINE CENTER FOR CANCER MEDICINE & BLOOD DISORDERS, P.A. D/B/A

Employer identification number (EIN): 010357684

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
509 2016-01-01 ISABELLA BOUFFARD ISABELLA BOUFFARD 2017-04-28
509 2016-01-01 TAMI HAMILTON 2022-01-13
509 2015-01-01 ISABELLA BOUFFARD ISABELLA BOUFFARD 2016-05-07

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
509	2016-01-01	ISABELLA BOUFFARD		ISABELLA BOUFFARD	2017-04-28
509	2016-01-01	TAMI HAMILTON	2022-01-13
509	2015-01-01	ISABELLA BOUFFARD		ISABELLA BOUFFARD	2016-05-07

Plan Statistics for MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN

401k plan membership statisitcs for MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN

Measure Date Value
2016: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 113
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 114
Number of other retired or separated participants entitled to future benefits 2016-01-01 2
Total of all active and inactive participants 2016-01-01 116
Total participants 2016-01-01 116
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of employers contributing to the scheme 2016-01-01 0
2015: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 105
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 110
Number of retired or separated participants receiving benefits 2015-01-01 3
Total of all active and inactive participants 2015-01-01 113
Total participants 2015-01-01 113

Measure	Date	Value
2016: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	113
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	114
Number of other retired or separated participants entitled to future benefits	2016-01-01	2
Total of all active and inactive participants	2016-01-01	116
Total participants	2016-01-01	116
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of employers contributing to the scheme	2016-01-01	0
2015: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	110
Number of retired or separated participants receiving benefits	2015-01-01	3
Total of all active and inactive participants	2015-01-01	113
Total participants	2015-01-01	113

Form 5500 Responses for MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN

2016: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS DENTAL PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05922154

Policy instance

Insurance contract or identification number	TM05922154
Number of Individuals Covered	363
Insurance policy start date	2016-01-01
Insurance policy end date	2016-12-31
Total amount of commissions paid to insurance broker	USD $7,496
Total amount of fees paid to insurance company	USD $2,534
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $123,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,311
Amount paid for insurance broker fees	1481
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

TM05922154

Policy instance

Insurance contract or identification number	TM05922154
Number of Individuals Covered	235
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,691
Total amount of fees paid to insurance company	USD $1,317
Are there contracts with allocated funds for individual policies?	No
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 $103,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,691
Amount paid for insurance broker fees	1317
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	ALLAINT INS SERVICES INC

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Company Name:	MAINE CENTER FOR CANCER MEDICINE & BLOOD DISORDERS, P.A. D/B/A
Employer identification number (EIN):	010357684
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)