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ACCESS DENTAL SERVICES, LLC WELFARE PLAN 401k Plan overview

Plan NameACCESS DENTAL SERVICES, LLC WELFARE PLAN
Plan identification number 501

ACCESS DENTAL SERVICES, LLC WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name:ACCESS DENTAL SERVICES, LLC
Employer identification number (EIN):471272105
NAIC Classification:524140

Additional information about ACCESS DENTAL SERVICES, LLC

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: 201419010342

More information about ACCESS DENTAL SERVICES, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ACCESS DENTAL SERVICES, LLC WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-12-01
5012016-12-01
5012015-12-01ROXANNE K ADAMS

Plan Statistics for ACCESS DENTAL SERVICES, LLC WELFARE PLAN

401k plan membership statisitcs for ACCESS DENTAL SERVICES, LLC WELFARE PLAN

Measure Date Value
2017: ACCESS DENTAL SERVICES, LLC WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-01269
Total number of active participants reported on line 7a of the Form 55002017-12-010
Number of retired or separated participants receiving benefits2017-12-010
Number of other retired or separated participants entitled to future benefits2017-12-010
Total of all active and inactive participants2017-12-010
2016: ACCESS DENTAL SERVICES, LLC WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-01184
Total number of active participants reported on line 7a of the Form 55002016-12-01269
Number of retired or separated participants receiving benefits2016-12-010
Number of other retired or separated participants entitled to future benefits2016-12-010
Total of all active and inactive participants2016-12-01269
2015: ACCESS DENTAL SERVICES, LLC WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-01100
Total number of active participants reported on line 7a of the Form 55002015-12-01184
Number of retired or separated participants receiving benefits2015-12-010
Number of other retired or separated participants entitled to future benefits2015-12-010
Total of all active and inactive participants2015-12-01184

Form 5500 Responses for ACCESS DENTAL SERVICES, LLC WELFARE PLAN

2017: ACCESS DENTAL SERVICES, LLC WELFARE PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01This submission is the final filingYes
2017-12-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan benefit arrangement – InsuranceYes
2016: ACCESS DENTAL SERVICES, LLC WELFARE PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan benefit arrangement – InsuranceYes
2015: ACCESS DENTAL SERVICES, LLC WELFARE PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01First time form 5500 has been submittedYes
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )
Policy contract number390-007
Policy instance 1
Insurance contract or identification number390-007
Number of Individuals Covered85
Insurance policy start date2017-12-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PREMIER ACCESS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60237 )
Policy contract number16000
Policy instance 2
Insurance contract or identification number16000
Number of Individuals Covered71
Insurance policy start date2017-12-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number649396
Policy instance 3
Insurance contract or identification number649396
Number of Individuals Covered0
Insurance policy start date2017-12-01
Insurance policy end date2017-12-31
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number522612
Policy instance 4
Insurance contract or identification number522612
Number of Individuals Covered254
Insurance policy start date2017-12-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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