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| Plan Name | CENTRAL COAST PEDIATRIC DENTAL GROUP LIFE/AD&D PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CENTRAL COAST PEDIATRIC DENTAL GROUP |
| Employer identification number (EIN): | 770204484 |
| NAIC Classification: | 621210 |
| NAIC Description: | Offices of Dentists |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2015-02-01 | KATHLEEN DIAZ | |||
| 502 | 2014-02-01 | KATHLEEN DIAZ | |||
| 502 | 2013-02-01 | KATHLEEN DIAZ | |||
| 502 | 2012-02-01 | KATHLEEN DIAZ |
| Measure | Date | Value |
|---|---|---|
| 2015: CENTRAL COAST PEDIATRIC DENTAL GROUP LIFE/AD&D PLAN 2015 401k membership | ||
| Total participants, beginning-of-year | 2015-02-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 0 |
| Number of retired or separated participants receiving benefits | 2015-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-02-01 | 0 |
| Total of all active and inactive participants | 2015-02-01 | 0 |
| 2014: CENTRAL COAST PEDIATRIC DENTAL GROUP LIFE/AD&D PLAN 2014 401k membership | ||
| Total participants, beginning-of-year | 2014-02-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 105 |
| Number of retired or separated participants receiving benefits | 2014-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-02-01 | 0 |
| Total of all active and inactive participants | 2014-02-01 | 105 |
| 2013: CENTRAL COAST PEDIATRIC DENTAL GROUP LIFE/AD&D PLAN 2013 401k membership | ||
| Total participants, beginning-of-year | 2013-02-01 | 111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 116 |
| Number of retired or separated participants receiving benefits | 2013-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-02-01 | 0 |
| Total of all active and inactive participants | 2013-02-01 | 116 |
| 2012: CENTRAL COAST PEDIATRIC DENTAL GROUP LIFE/AD&D PLAN 2012 401k membership | ||
| Total participants, beginning-of-year | 2012-02-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 111 |
| Number of retired or separated participants receiving benefits | 2012-02-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-02-01 | 0 |
| Total of all active and inactive participants | 2012-02-01 | 111 |
| 2015: CENTRAL COAST PEDIATRIC DENTAL GROUP LIFE/AD&D PLAN 2015 form 5500 responses | ||
|---|---|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Submission has been amended | No |
| 2015-02-01 | This submission is the final filing | Yes |
| 2015-02-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2015-02-01 | Plan is a collectively bargained plan | No |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: CENTRAL COAST PEDIATRIC DENTAL GROUP LIFE/AD&D PLAN 2014 form 5500 responses | ||
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Submission has been amended | No |
| 2014-02-01 | This submission is the final filing | No |
| 2014-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-02-01 | Plan is a collectively bargained plan | No |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: CENTRAL COAST PEDIATRIC DENTAL GROUP LIFE/AD&D PLAN 2013 form 5500 responses | ||
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Submission has been amended | No |
| 2013-02-01 | This submission is the final filing | No |
| 2013-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-02-01 | Plan is a collectively bargained plan | No |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: CENTRAL COAST PEDIATRIC DENTAL GROUP LIFE/AD&D PLAN 2012 form 5500 responses | ||
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | First time form 5500 has been submitted | Yes |
| 2012-02-01 | Submission has been amended | No |
| 2012-02-01 | This submission is the final filing | No |
| 2012-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-02-01 | Plan is a collectively bargained plan | No |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 277115 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 277115 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 277115 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy contract number | 277115 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Policy instance | 1 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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