401k Plan data: DENTAL INSURANCE BENEFITS plan

DENTAL INSURANCE BENEFITS 401k Plan overview

Plan Name	DENTAL INSURANCE BENEFITS
Plan identification number	502

DENTAL INSURANCE BENEFITS Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

PACIFIC PROCESS SYSTEMS, INC. has sponsored the creation of one or more 401k plans.

Company Name: PACIFIC PROCESS SYSTEMS, INC.

Employer identification number (EIN): 770407110

NAIC Classification: 213110
NAIC Description: Support Activities for Mining

Additional information about PACIFIC PROCESS SYSTEMS, INC.

Jurisdiction of Incorporation: California Department of State

Incorporation Date: 1995-07-17

Company Identification Number: C1923277

Legal Registered Office Address: 5055 California Ave., Suite 220

Bakersfield
United States of America (USA)
93309

More information about PACIFIC PROCESS SYSTEMS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DENTAL INSURANCE BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-01-01 JERRY WISE
502 2014-01-01 JERRY WISE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2015-01-01	JERRY WISE
502	2014-01-01	JERRY WISE

Plan Statistics for DENTAL INSURANCE BENEFITS

401k plan membership statisitcs for DENTAL INSURANCE BENEFITS

Measure Date Value
2015: DENTAL INSURANCE BENEFITS 2015 401k membership
Total participants, beginning-of-year 2015-01-01 64
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 113
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 113
2014: DENTAL INSURANCE BENEFITS 2014 401k membership
Total participants, beginning-of-year 2014-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 64
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 64

Measure	Date	Value
2015: DENTAL INSURANCE BENEFITS 2015 401k membership
Total participants, beginning-of-year	2015-01-01	64
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	113
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	113
2014: DENTAL INSURANCE BENEFITS 2014 401k membership
Total participants, beginning-of-year	2014-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	64
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	64

Form 5500 Responses for DENTAL INSURANCE BENEFITS

2015: DENTAL INSURANCE BENEFITS 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: DENTAL INSURANCE BENEFITS 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )

Policy contract number

805091

Policy instance

Insurance contract or identification number	805091
Number of Individuals Covered	266
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $43,858
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $983,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $43,858
Insurance broker organization code?	3
Insurance broker name	TOLMAN AND WIKER INS. SVCS., LLC

ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 )

Policy contract number

225595

Policy instance

Insurance contract or identification number	225595
Number of Individuals Covered	150
Insurance policy start date	2013-08-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $11,779
Total amount of fees paid to insurance company	USD $1,852
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $117,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $11,779
Amount paid for insurance broker fees	1852
Additional information about fees paid to insurance broker	INDIRECT COMPENSATION
Insurance broker organization code?	3
Insurance broker name	TOLMAN AND WIKER INS. SERVICES, LLC

Potentially related plans

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Company Name:	PACIFIC PROCESS SYSTEMS, INC.
Employer identification number (EIN):	770407110
NAIC Classification:	213110
NAIC Description:	Support Activities for Mining

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:	1995-07-17
Company Identification Number:	C1923277
Legal Registered Office Address:	5055 California Ave., Suite 220 Bakersfield United States of America (USA) 93309