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CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 401k Plan overview

Plan NameCALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN
Plan identification number 501

CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 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
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. has sponsored the creation of one or more 401k plans.

Company Name:CALIFORNIA HEALTHCARE MEDICAL BILLING, INC.
Employer identification number (EIN):330705683
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Additional information about CALIFORNIA HEALTHCARE MEDICAL BILLING, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2018-02-09
Company Identification Number: 0802937554
Legal Registered Office Address: 2112 BOLL ST # 2509

DALLAS
United States of America (USA)
75204

More information about CALIFORNIA HEALTHCARE MEDICAL BILLING, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-09-01
5012016-09-01PHEBE JONES PHEBE JONES2018-02-26
5012015-09-01PHEBE JONES
5012014-09-01PHEBE JONES PHEBE JONES2016-03-10
5012013-09-01PHEBE JONES PHEBE JONES2015-02-23
5012012-09-01PHEBE JONES PHEBE JONES2014-01-29
5012011-09-01DONNA FORSTER
5012010-09-01JACK DALEO
5012009-09-01JACK DALEO

Plan Statistics for CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN

401k plan membership statisitcs for CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN

Measure Date Value
2017: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01473
Total number of active participants reported on line 7a of the Form 55002017-09-010
Number of retired or separated participants receiving benefits2017-09-010
Number of other retired or separated participants entitled to future benefits2017-09-010
Total of all active and inactive participants2017-09-010
2016: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01328
Total number of active participants reported on line 7a of the Form 55002016-09-01445
Number of retired or separated participants receiving benefits2016-09-011
Number of other retired or separated participants entitled to future benefits2016-09-010
Total of all active and inactive participants2016-09-01446
2015: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01319
Total number of active participants reported on line 7a of the Form 55002015-09-01325
Number of retired or separated participants receiving benefits2015-09-013
Number of other retired or separated participants entitled to future benefits2015-09-010
Total of all active and inactive participants2015-09-01328
2014: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-01389
Total number of active participants reported on line 7a of the Form 55002014-09-01318
Number of retired or separated participants receiving benefits2014-09-011
Number of other retired or separated participants entitled to future benefits2014-09-010
Total of all active and inactive participants2014-09-01319
2013: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-01354
Total number of active participants reported on line 7a of the Form 55002013-09-01383
Number of retired or separated participants receiving benefits2013-09-016
Number of other retired or separated participants entitled to future benefits2013-09-010
Total of all active and inactive participants2013-09-01389
2012: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-01300
Total number of active participants reported on line 7a of the Form 55002012-09-01341
Number of retired or separated participants receiving benefits2012-09-0113
Number of other retired or separated participants entitled to future benefits2012-09-010
Total of all active and inactive participants2012-09-01354
2011: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-01289
Total number of active participants reported on line 7a of the Form 55002011-09-01298
Number of retired or separated participants receiving benefits2011-09-012
Number of other retired or separated participants entitled to future benefits2011-09-010
Total of all active and inactive participants2011-09-01300
2010: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2010 401k membership
Total participants, beginning-of-year2010-09-01303
Total number of active participants reported on line 7a of the Form 55002010-09-01283
Number of retired or separated participants receiving benefits2010-09-016
Number of other retired or separated participants entitled to future benefits2010-09-010
Total of all active and inactive participants2010-09-01289
2009: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-01236
Total number of active participants reported on line 7a of the Form 55002009-09-01301
Number of retired or separated participants receiving benefits2009-09-012
Number of other retired or separated participants entitled to future benefits2009-09-010
Total of all active and inactive participants2009-09-01303

Form 5500 Responses for CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN

2017: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Submission has been amendedNo
2017-09-01This submission is the final filingYes
2017-09-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-09-01Plan is a collectively bargained planNo
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – InsuranceYes
2016: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Submission has been amendedNo
2016-09-01This submission is the final filingNo
2016-09-01This return/report is a short plan year return/report (less than 12 months)No
2016-09-01Plan is a collectively bargained planNo
2016-09-01Plan funding arrangement – General assets of the sponsorYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Submission has been amendedNo
2015-09-01This submission is the final filingNo
2015-09-01This return/report is a short plan year return/report (less than 12 months)No
2015-09-01Plan is a collectively bargained planNo
2015-09-01Plan funding arrangement – General assets of the sponsorYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Submission has been amendedNo
2014-09-01This submission is the final filingNo
2014-09-01This return/report is a short plan year return/report (less than 12 months)No
2014-09-01Plan is a collectively bargained planNo
2014-09-01Plan funding arrangement – General assets of the sponsorYes
2014-09-01Plan benefit arrangement – InsuranceYes
2013: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Submission has been amendedNo
2013-09-01This submission is the final filingNo
2013-09-01This return/report is a short plan year return/report (less than 12 months)No
2013-09-01Plan is a collectively bargained planNo
2013-09-01Plan funding arrangement – General assets of the sponsorYes
2013-09-01Plan benefit arrangement – InsuranceYes
2012: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Submission has been amendedNo
2012-09-01This submission is the final filingNo
2012-09-01This return/report is a short plan year return/report (less than 12 months)No
2012-09-01Plan is a collectively bargained planNo
2012-09-01Plan funding arrangement – General assets of the sponsorYes
2012-09-01Plan benefit arrangement – InsuranceYes
2011: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Submission has been amendedNo
2011-09-01This submission is the final filingNo
2011-09-01This return/report is a short plan year return/report (less than 12 months)No
2011-09-01Plan is a collectively bargained planNo
2011-09-01Plan funding arrangement – General assets of the sponsorYes
2011-09-01Plan benefit arrangement – InsuranceYes
2010: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2010 form 5500 responses
2010-09-01Type of plan entitySingle employer plan
2010-09-01Submission has been amendedNo
2010-09-01This submission is the final filingNo
2010-09-01This return/report is a short plan year return/report (less than 12 months)No
2010-09-01Plan is a collectively bargained planNo
2010-09-01Plan funding arrangement – InsuranceYes
2010-09-01Plan benefit arrangement – InsuranceYes
2009: CALIFORNIA HEALTHCARE MEDICAL BILLING, INC. WELFARE BENEFITS PLAN 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01Submission has been amendedNo
2009-09-01This submission is the final filingNo
2009-09-01This return/report is a short plan year return/report (less than 12 months)No
2009-09-01Plan is a collectively bargained planNo
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1008220
Policy instance 1
Insurance contract or identification number1008220
Number of Individuals Covered548
Insurance policy start date2017-09-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $14,178
Total amount of fees paid to insurance companyUSD $1,140
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $239,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,178
Insurance broker organization code?3
Amount paid for insurance broker fees1140
Additional information about fees paid to insurance brokerBONUS
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
HEALTH AND HUMAN RESOURCES CENTER, INC. (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number583440
Policy instance 9
Insurance contract or identification number583440
Number of Individuals Covered87
Insurance policy start date2017-09-01
Insurance policy end date2018-06-30
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
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 $1,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number97927301001
Policy instance 8
Insurance contract or identification number97927301001
Number of Individuals Covered609
Insurance policy start date2017-09-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $3,326
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Dental Insurance Welfare BenefitNo
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 $30,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,326
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number23416
Policy instance 7
Insurance contract or identification number23416
Number of Individuals Covered70
Insurance policy start date2017-09-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $6,897
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS
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 $10,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,897
Insurance broker organization code?3
Insurance broker nameVARIOUS - SEE ATTACHMENT
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number563971HNO
Policy instance 6
Insurance contract or identification number563971HNO
Number of Individuals Covered380
Insurance policy start date2017-09-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $79,171
Total amount of fees paid to insurance companyUSD $4,562
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Vision Insurance Welfare BenefitNo
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 $1,876,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $79,171
Amount paid for insurance broker fees4562
Additional information about fees paid to insurance broker2016-2017 PPP INCENTIVE
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract numberP81306
Policy instance 5
Insurance contract or identification numberP81306
Number of Individuals Covered550
Insurance policy start date2017-09-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $5,893
Total amount of fees paid to insurance companyUSD $2,703
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $53,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,893
Amount paid for insurance broker fees2703
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 )
Policy contract numberK4J83
Policy instance 4
Insurance contract or identification numberK4J83
Number of Individuals Covered17
Insurance policy start date2017-09-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $2,212
Total amount of fees paid to insurance companyUSD $34
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT, CANCER, SPECIFIED HEALTH EVENT
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 $14,652
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,212
Amount paid for insurance broker fees34
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameVARIOUS - SEE ATTACHMENT
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number563971
Policy instance 3
Insurance contract or identification number563971
Number of Individuals Covered59
Insurance policy start date2017-09-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $10,175
Total amount of fees paid to insurance companyUSD $5,695
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Vision Insurance Welfare BenefitNo
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 $279,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,175
Amount paid for insurance broker fees5695
Additional information about fees paid to insurance broker2017 PPP ENGAGEMENT CREDIT MEDICAL RETENTION
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
CALIFORNIA DENTAL NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number001613
Policy instance 2
Insurance contract or identification number001613
Number of Individuals Covered104
Insurance policy start date2017-09-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $1,578
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
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 $15,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,578
Insurance broker organization code?3
Insurance broker nameBARNEY & BARNEY
HEALTH AND HUMAN RESOURCES CENTER, INC. (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number583392
Policy instance 10
Insurance contract or identification number583392
Number of Individuals Covered459
Insurance policy start date2017-09-01
Insurance policy end date2018-06-30
Are there contracts with allocated funds for individual policies?0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedEMPLOYEE ASSISTANCE PROGRAM
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 $5,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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