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DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES 401k Plan overview

Plan NameDDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES
Plan identification number 515

DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES Benefits

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

401k Sponsoring company profile

DELTA DENTAL PLAN OF MICHIGAN, INC. has sponsored the creation of one or more 401k plans.

Company Name:DELTA DENTAL PLAN OF MICHIGAN, INC.
Employer identification number (EIN):381791480
NAIC Classification:524290

Additional information about DELTA DENTAL PLAN OF MICHIGAN, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2003-10-03
Company Identification Number: 0800254463
Legal Registered Office Address: PO BOX 30416

LANSING
United States of America (USA)
48909

More information about DELTA DENTAL PLAN OF MICHIGAN, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5152022-01-01AMY BASEL2023-06-05
5152021-01-01AMY BASEL2022-07-11
5152020-01-01AMY BASEL2021-04-21
5152019-01-01AMY BASEL2020-04-20
5152018-01-01AMY BASEL2019-05-16
5152017-01-01AMY BASEL2018-09-10
5152016-01-01AMY BASEL2017-09-08
5152016-01-01AMY BASEL2018-06-19
5152015-01-01GORAN JURKOVIC2016-10-01
5152015-01-01AMY BASEL2018-06-19
5152014-01-01GORAN JURKOVIC2015-10-14
5152014-01-01AMY BASEL2018-06-19
5152013-01-01GORAN JURKOVIC2016-01-05
5152013-01-01AMY BASEL2018-06-19
5152012-01-01GORAN JURKOVIC2013-10-13
5152011-01-01GORAN JURKOVIC
5152010-01-01GORAN JURKOVIC
5152009-01-01GORAN JURKOVIC

Plan Statistics for DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES

401k plan membership statisitcs for DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES

Measure Date Value
2011: DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES 2011 401k membership
Total participants, beginning-of-year2011-01-01137
Total number of active participants reported on line 7a of the Form 55002011-01-010
Number of retired or separated participants receiving benefits2011-01-0197
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0197
2010: DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES 2010 401k membership
Total participants, beginning-of-year2010-01-01134
Total number of active participants reported on line 7a of the Form 55002010-01-010
Number of retired or separated participants receiving benefits2010-01-01136
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01136
2009: DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES 2009 401k membership
Total participants, beginning-of-year2009-01-0192
Total number of active participants reported on line 7a of the Form 55002009-01-01134
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01134

Financial Data on DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES

Measure Date Value
2011 : DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$-84,491
Total unrealized appreciation/depreciation of assets2011-12-31$-84,491
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$6,078
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$318,911
Total income from all sources (including contributions)2011-12-31$35,088
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$897,104
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$801,179
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$233,338
Value of total assets at end of year2011-12-31$11,939,141
Value of total assets at beginning of year2011-12-31$13,113,990
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$95,925
Total interest from all sources2011-12-31$1,647
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$323,909
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$309,412
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$5,000,000
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$233,338
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-12-31$27,634
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$103,331
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$82,878
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$6,078
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$315,436
Administrative expenses (other) incurred2011-12-31$9,012
Liabilities. Value of operating payables at end of year2011-12-31$0
Liabilities. Value of operating payables at beginning of year2011-12-31$3,475
Total non interest bearing cash at end of year2011-12-31$1,555
Total non interest bearing cash at beginning of year2011-12-31$5,294
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-862,016
Value of net assets at end of year (total assets less liabilities)2011-12-31$11,933,063
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$12,795,079
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Investment advisory and management fees2011-12-31$7,343
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$10,246,893
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$10,449,119
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$515,248
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$1,659,625
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$1,659,625
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$1,647
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$773,545
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-439,315
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Employer contributions (assets) at end of year2011-12-31$274,560
Employer contributions (assets) at beginning of year2011-12-31$0
Income. Dividends from common stock2011-12-31$14,497
Contract administrator fees2011-12-31$79,570
Assets. Corporate common stocks other than exployer securities at end of year2011-12-31$797,554
Assets. Corporate common stocks other than exployer securities at beginning of year2011-12-31$917,074
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31PLANTE & MORAN, PLLC
Accountancy firm EIN2011-12-31381357951
2010 : DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$90,111
Total unrealized appreciation/depreciation of assets2010-12-31$90,111
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$318,911
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$1,780,058
Total loss/gain on sale of assets2010-12-31$27,943
Total of all expenses incurred2010-12-31$1,684,015
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,585,900
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$309,891
Value of total assets at end of year2010-12-31$13,113,990
Value of total assets at beginning of year2010-12-31$12,699,036
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$98,115
Total interest from all sources2010-12-31$1,126
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$327,288
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$315,011
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$5,000,000
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$129,744
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2010-12-31$2,440
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$82,878
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$4,315
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$315,436
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$0
Other income not declared elsewhere2010-12-31$99
Administrative expenses (other) incurred2010-12-31$3,395
Liabilities. Value of operating payables at end of year2010-12-31$3,475
Liabilities. Value of operating payables at beginning of year2010-12-31$0
Total non interest bearing cash at end of year2010-12-31$5,294
Total non interest bearing cash at beginning of year2010-12-31$73
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$96,043
Value of net assets at end of year (total assets less liabilities)2010-12-31$12,795,079
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$12,699,036
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Investment advisory and management fees2010-12-31$7,762
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$10,449,119
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$10,945,745
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$1,659,625
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$948,173
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$948,173
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$1,126
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$1,583,460
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$1,023,600
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$180,147
Income. Dividends from common stock2010-12-31$12,277
Contract administrator fees2010-12-31$86,958
Assets. Corporate common stocks other than exployer securities at end of year2010-12-31$917,074
Assets. Corporate common stocks other than exployer securities at beginning of year2010-12-31$800,730
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Aggregate proceeds on sale of assets2010-12-31$187,303
Aggregate carrying amount (costs) on sale of assets2010-12-31$159,360
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31PLANTE & MORAN, PLLC
Accountancy firm EIN2010-12-31381357951

Form 5500 Responses for DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES

2011: DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planYes
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: DDPMI WELFARE BENEFIT PLAN FOR RETIRED EMPLOYEES 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number42294
Policy instance 1
Insurance contract or identification number42294
Number of Individuals Covered127
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
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
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 $27,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number42294
Policy instance 1
Insurance contract or identification number42294
Number of Individuals Covered127
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
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
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 $2,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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