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THE NORTH STATE DENTAL PARTNERS HEALTH & WELFARE P 401k Plan overview

Plan NameTHE NORTH STATE DENTAL PARTNERS HEALTH & WELFARE P
Plan identification number 501

THE NORTH STATE DENTAL PARTNERS HEALTH & WELFARE P Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

NORTH STATE DENTAL PARTNERS, INC. has sponsored the creation of one or more 401k plans.

Company Name:NORTH STATE DENTAL PARTNERS, INC.
Employer identification number (EIN):263879799
NAIC Classification:561110
NAIC Description:Office Administrative Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE NORTH STATE DENTAL PARTNERS HEALTH & WELFARE P

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01

Plan Statistics for THE NORTH STATE DENTAL PARTNERS HEALTH & WELFARE P

401k plan membership statisitcs for THE NORTH STATE DENTAL PARTNERS HEALTH & WELFARE P

Measure Date Value
2021: THE NORTH STATE DENTAL PARTNERS HEALTH & WELFARE P 2021 401k membership
Total participants, beginning-of-year2021-12-0181
Total number of active participants reported on line 7a of the Form 55002021-12-01120
Number of retired or separated participants receiving benefits2021-12-010
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-01120

Form 5500 Responses for THE NORTH STATE DENTAL PARTNERS HEALTH & WELFARE P

2021: THE NORTH STATE DENTAL PARTNERS HEALTH & WELFARE P 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan funding arrangement – General assets of the sponsorYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AY7R
Policy instance 1
Insurance contract or identification numberG000AY7R
Number of Individuals Covered120
Insurance policy start date2021-12-01
Insurance policy end date2022-12-01
Total amount of commissions paid to insurance brokerUSD $587
Total amount of fees paid to insurance companyUSD $152
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $587
Amount paid for insurance broker fees152
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AY7R
Policy instance 2
Insurance contract or identification numberG000AY7R
Number of Individuals Covered41
Insurance policy start date2021-12-01
Insurance policy end date2022-12-01
Total amount of commissions paid to insurance brokerUSD $5,400
Total amount of fees paid to insurance companyUSD $1,460
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,400
Amount paid for insurance broker fees1460
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AY7R
Policy instance 3
Insurance contract or identification numberG000AY7R
Number of Individuals Covered45
Insurance policy start date2021-12-01
Insurance policy end date2022-12-01
Total amount of commissions paid to insurance brokerUSD $2,119
Total amount of fees paid to insurance companyUSD $563
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $14,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,119
Amount paid for insurance broker fees563
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?4
BLUECROSS BLUESHIELD OF NORTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 54631 )
Policy contract number14165104
Policy instance 4
Insurance contract or identification number14165104
Number of Individuals Covered51
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $29,729
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedWELLNESS
Welfare Benefit Premiums Paid to CarrierUSD $709,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,729
Insurance broker organization code?3
COMMUNITY EYE CARE (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberTPO35012
Policy instance 5
Insurance contract or identification numberTPO35012
Number of Individuals Covered96
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $1,231
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,312
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,231

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