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DENTISTRY FOR CHILDREN MEDICAL PLAN 401k Plan overview

Plan NameDENTISTRY FOR CHILDREN MEDICAL PLAN
Plan identification number 501

DENTISTRY FOR CHILDREN MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

D4C DENTAL BRANDS, INC. has sponsored the creation of one or more 401k plans.

Company Name:D4C DENTAL BRANDS, INC.
Employer identification number (EIN):273864352
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DENTISTRY FOR CHILDREN MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-01-01ALISTAIR MADLE
5012014-06-01ALISTAIR MADLE
5012013-06-01JEFFREY BATZEL
5012012-06-01STEVEN E. RUSSELL
5012011-06-01STEVEN E. RUSSEU

Plan Statistics for DENTISTRY FOR CHILDREN MEDICAL PLAN

401k plan membership statisitcs for DENTISTRY FOR CHILDREN MEDICAL PLAN

Measure Date Value
2015: DENTISTRY FOR CHILDREN MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01292
Total number of active participants reported on line 7a of the Form 55002015-01-01277
Number of retired or separated participants receiving benefits2015-01-012
Total of all active and inactive participants2015-01-01279
2014: DENTISTRY FOR CHILDREN MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01338
Total number of active participants reported on line 7a of the Form 55002014-06-01290
Number of retired or separated participants receiving benefits2014-06-012
Total of all active and inactive participants2014-06-01292
2013: DENTISTRY FOR CHILDREN MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01266
Total number of active participants reported on line 7a of the Form 55002013-06-01338
Total of all active and inactive participants2013-06-01338
2012: DENTISTRY FOR CHILDREN MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01261
Total number of active participants reported on line 7a of the Form 55002012-06-01266
Number of retired or separated participants receiving benefits2012-06-010
Number of other retired or separated participants entitled to future benefits2012-06-010
Total of all active and inactive participants2012-06-01266
2011: DENTISTRY FOR CHILDREN MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01100
Total number of active participants reported on line 7a of the Form 55002011-06-01261
Number of retired or separated participants receiving benefits2011-06-010
Number of other retired or separated participants entitled to future benefits2011-06-010
Total of all active and inactive participants2011-06-01261

Form 5500 Responses for DENTISTRY FOR CHILDREN MEDICAL PLAN

2015: DENTISTRY FOR CHILDREN MEDICAL PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: DENTISTRY FOR CHILDREN MEDICAL PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Submission has been amendedNo
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)Yes
2014-06-01Plan is a collectively bargained planNo
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: DENTISTRY FOR CHILDREN MEDICAL PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Submission has been amendedNo
2013-06-01This submission is the final filingNo
2013-06-01This return/report is a short plan year return/report (less than 12 months)No
2013-06-01Plan is a collectively bargained planNo
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: DENTISTRY FOR CHILDREN MEDICAL PLAN 2012 form 5500 responses
2012-06-01Type of plan entityMulitple employer plan
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingNo
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planNo
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: DENTISTRY FOR CHILDREN MEDICAL PLAN 2011 form 5500 responses
2011-06-01Type of plan entityMulitple employer plan
2011-06-01First time form 5500 has been submittedYes
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)No
2011-06-01Plan is a collectively bargained planNo
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract numberIVPE
Policy instance 1
Insurance contract or identification numberIVPE
Number of Individuals Covered27
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Total amount of commissions paid to insurance brokerUSD $4,074
Total amount of fees paid to insurance companyUSD $2,200
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,344
Commission paid to Insurance BrokerUSD $3,150
Amount paid for insurance broker fees7
Additional information about fees paid to insurance brokerNON-MONETARY INCENTIVE
Insurance broker organization code?3
Insurance broker nameEBCA
COVENTRY HEALTH CARE OF GEORGIA (National Association of Insurance Commissioners NAIC id number: 95282 )
Policy contract number6538840000
Policy instance 2
Insurance contract or identification number6538840000
Number of Individuals Covered383
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $75,795
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,515,909
Commission paid to Insurance BrokerUSD $75,795
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number6538840000
Policy instance 3
Insurance contract or identification number6538840000
Number of Individuals Covered42
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $8,483
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $169,659
Commission paid to Insurance BrokerUSD $8,483
Insurance broker organization code?3
Insurance broker nameNORTHWESTERN BENEFIT CORP OF GA
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number6538840000
Policy instance 1
Insurance contract or identification number6538840000
Number of Individuals Covered30
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $1,518
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,595
Commission paid to Insurance BrokerUSD $1,518
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
COVENTRY HEALTH CARE OF GEORGIA (National Association of Insurance Commissioners NAIC id number: 95282 )
Policy contract number6538840000
Policy instance 2
Insurance contract or identification number6538840000
Number of Individuals Covered391
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $27,785
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $926,178
Commission paid to Insurance BrokerUSD $27,785
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
COVENTRY HEALTH CARE OF GEORGIA (National Association of Insurance Commissioners NAIC id number: 95282 )
Policy contract number6538840000
Policy instance 1
Insurance contract or identification number6538840000
Number of Individuals Covered314
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $32,025
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,067,514
Commission paid to Insurance BrokerUSD $32,025
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number6538840000
Policy instance 2
Insurance contract or identification number6538840000
Number of Individuals Covered24
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $2,933
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $97,756
Commission paid to Insurance BrokerUSD $2,933
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3334369
Policy instance 1
Insurance contract or identification number3334369
Number of Individuals Covered266
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $8,042
Total amount of fees paid to insurance companyUSD $37,442
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,370,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,042
Amount paid for insurance broker fees37442
Additional information about fees paid to insurance brokerBENEFIT ADVISOR PAYMENTS
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3334369
Policy instance 1
Insurance contract or identification number3334369
Number of Individuals Covered261
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $66,079
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $1,281,481
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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