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PDS VEBA TRUST GROUP INSURANCE ARRANGEMENT FOR AFFILIATE EMPLOYERS 401k Plan overview

Plan NamePDS VEBA TRUST GROUP INSURANCE ARRANGEMENT FOR AFFILIATE EMPLOYERS
Plan identification number 503

PDS VEBA TRUST GROUP INSURANCE ARRANGEMENT FOR AFFILIATE EMPLOYERS Benefits

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

401k Sponsoring company profile

PACIFIC DENTAL SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name:PACIFIC DENTAL SERVICES, LLC
Employer identification number (EIN):330681491
NAIC Classification:551112
NAIC Description:Offices of Other Holding Companies

Additional information about PACIFIC DENTAL SERVICES, LLC

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2009-11-09
Company Identification Number: 0801192046
Legal Registered Office Address: PO BOX 19723

IRVINE
United States of America (USA)
92623

More information about PACIFIC DENTAL SERVICES, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PDS VEBA TRUST GROUP INSURANCE ARRANGEMENT FOR AFFILIATE EMPLOYERS

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-01-01TAYLOR HAWES2023-10-16

Plan Statistics for PDS VEBA TRUST GROUP INSURANCE ARRANGEMENT FOR AFFILIATE EMPLOYERS

401k plan membership statisitcs for PDS VEBA TRUST GROUP INSURANCE ARRANGEMENT FOR AFFILIATE EMPLOYERS

Measure Date Value
2022: PDS VEBA TRUST GROUP INSURANCE ARRANGEMENT FOR AFFILIATE EMPLOYERS 2022 401k membership
Total participants, beginning-of-year2022-01-012,113
Total number of active participants reported on line 7a of the Form 55002022-01-012,108
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-012,108
Number of employers contributing to the scheme2022-01-010

Financial Data on PDS VEBA TRUST GROUP INSURANCE ARRANGEMENT FOR AFFILIATE EMPLOYERS

Measure Date Value
2022 : PDS VEBA TRUST GROUP INSURANCE ARRANGEMENT FOR AFFILIATE EMPLOYERS 2022 401k financial data
Total income from all sources (including contributions)2022-12-31$17,275,248
Total of all expenses incurred2022-12-31$17,274,889
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$17,274,889
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$17,275,039
Value of total assets at end of year2022-12-31$359
Value of total assets at beginning of year2022-12-31$0
Total interest from all sources2022-12-31$209
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$5,127,627
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$359
Value of net assets at end of year (total assets less liabilities)2022-12-31$359
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$359
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$209
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$17,274,889
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$12,147,412
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31WINDES, INC.
Accountancy firm EIN2022-12-31953001179

Form 5500 Responses for PDS VEBA TRUST GROUP INSURANCE ARRANGEMENT FOR AFFILIATE EMPLOYERS

2022: PDS VEBA TRUST GROUP INSURANCE ARRANGEMENT FOR AFFILIATE EMPLOYERS 2022 form 5500 responses
2022-01-01Type of plan entityMulitple employer plan
2022-01-01First time form 5500 has been submittedYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )
Policy contract number174300
Policy instance 1
Insurance contract or identification number174300
Number of Individuals Covered3588
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,255,645
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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