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MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 401k Plan overview

Plan NameMONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST
Plan identification number 501

MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST Benefits

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

401k Sponsoring company profile

MONTANA DENTAL ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name:MONTANA DENTAL ASSOCIATION
Employer identification number (EIN):810531377
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-01-01AL GARVER
5012018-01-01AL GARVER2019-10-04
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01DAVID HEMION DAVID HEMION2014-08-25
5012012-01-01JEAN STRAINER JEAN STRAINER2013-10-15
5012011-01-01JEAN STRAINER JEAN STRAINER2012-10-15
5012010-01-01JEAN STRAINER JEAN STRAINER2011-10-14
5012009-01-01JEAN STRAINER JEAN STRAINER2010-10-05

Plan Statistics for MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST

401k plan membership statisitcs for MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST

Measure Date Value
2019: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-010
Total number of active participants reported on line 7a of the Form 55002019-01-010
Total of all active and inactive participants2019-01-010
2018: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2018 401k membership
Total participants, beginning-of-year2018-01-010
Total number of active participants reported on line 7a of the Form 55002018-01-010
Total of all active and inactive participants2018-01-010
2017: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-010
Total number of active participants reported on line 7a of the Form 55002017-01-010
Total of all active and inactive participants2017-01-010
2016: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-01279
Total number of active participants reported on line 7a of the Form 55002016-01-010
Total of all active and inactive participants2016-01-010
2015: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-01276
Total number of active participants reported on line 7a of the Form 55002015-01-01279
Total of all active and inactive participants2015-01-01279
2014: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-01262
Total number of active participants reported on line 7a of the Form 55002014-01-01276
Total of all active and inactive participants2014-01-01276
2013: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-01221
Total number of active participants reported on line 7a of the Form 55002013-01-01262
Total of all active and inactive participants2013-01-01262
2012: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-01241
Total number of active participants reported on line 7a of the Form 55002012-01-01221
Total of all active and inactive participants2012-01-01221
2011: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-01265
Total number of active participants reported on line 7a of the Form 55002011-01-01241
Total of all active and inactive participants2011-01-01241
2010: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2010 401k membership
Total participants, beginning-of-year2010-01-01258
Total number of active participants reported on line 7a of the Form 55002010-01-01265
Total of all active and inactive participants2010-01-01265
2009: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-01275
Total number of active participants reported on line 7a of the Form 55002009-01-01268
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 participants2009-01-01268

Financial Data on MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST

Measure Date Value
2019 : MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2019 401k financial data
Total plan liabilities at end of year2019-12-31$0
Total plan liabilities at beginning of year2019-12-31$12,928
Total income from all sources2019-12-31$30
Expenses. Total of all expenses incurred2019-12-31$181,753
Benefits paid (including direct rollovers)2019-12-31$180,720
Total plan assets at end of year2019-12-31$0
Total plan assets at beginning of year2019-12-31$194,651
Expenses. Other expenses not covered elsewhere2019-12-31$171
Other income received2019-12-31$30
Net income (gross income less expenses)2019-12-31$-181,723
Net plan assets at end of year (total assets less liabilities)2019-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$181,723
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$862
2018 : MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2018 401k financial data
Total plan liabilities at end of year2018-12-31$12,928
Total income from all sources2018-12-31$5
Expenses. Total of all expenses incurred2018-12-31$29,145
Total plan assets at end of year2018-12-31$194,651
Total plan assets at beginning of year2018-12-31$210,863
Value of fidelity bond covering the plan2018-12-31$1,000,000
Expenses. Other expenses not covered elsewhere2018-12-31$8,191
Other income received2018-12-31$5
Net income (gross income less expenses)2018-12-31$-29,140
Net plan assets at end of year (total assets less liabilities)2018-12-31$181,723
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$210,863
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$20,954
2017 : MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2017 401k financial data
Total plan liabilities at end of year2017-12-31$0
Total plan liabilities at beginning of year2017-12-31$45,028
Total income from all sources2017-12-31$18,227
Expenses. Total of all expenses incurred2017-12-31$14,814
Total plan assets at end of year2017-12-31$210,863
Total plan assets at beginning of year2017-12-31$252,478
Expenses. Other expenses not covered elsewhere2017-12-31$10,125
Other income received2017-12-31$18,227
Net income (gross income less expenses)2017-12-31$3,413
Net plan assets at end of year (total assets less liabilities)2017-12-31$210,863
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$207,450
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$4,689
2016 : MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$-52,426
Total unrealized appreciation/depreciation of assets2016-12-31$-52,426
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$45,028
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$849,563
Total income from all sources (including contributions)2016-12-31$1,997,943
Total loss/gain on sale of assets2016-12-31$86,857
Total of all expenses incurred2016-12-31$2,484,107
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$2,229,846
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,952,996
Value of total assets at end of year2016-12-31$252,478
Value of total assets at beginning of year2016-12-31$1,543,177
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$254,261
Total interest from all sources2016-12-31$155
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$10,361
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$107,611
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$1,000,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Assets. Other investments not covered elsewhere at beginning of year2016-12-31$1,910
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$15,958
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$1,728
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$349,023
Administrative expenses (other) incurred2016-12-31$49,967
Liabilities. Value of operating payables at end of year2016-12-31$16,660
Liabilities. Value of operating payables at beginning of year2016-12-31$45,203
Total non interest bearing cash at end of year2016-12-31$238,080
Total non interest bearing cash at beginning of year2016-12-31$2,393
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-486,164
Value of net assets at end of year (total assets less liabilities)2016-12-31$207,450
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$693,614
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$5,576
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$584,105
Interest earned on other investments2016-12-31$155
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$12,670
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$35,953
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$35,953
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$154,196
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$1,937,038
Employer contributions (assets) at beginning of year2016-12-31$6,979
Income. Dividends from common stock2016-12-31$10,361
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$2,075,650
Asset. Corporate debt instrument debt (other) at beginning of year2016-12-31$25,050
Contract administrator fees2016-12-31$91,107
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Assets. Corporate common stocks other than exployer securities at beginning of year2016-12-31$537,764
Liabilities. Value of benefit claims payable at end of year2016-12-31$28,368
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$804,360
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Aggregate proceeds on sale of assets2016-12-31$1,311,947
Aggregate carrying amount (costs) on sale of assets2016-12-31$1,225,090
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31DOUGLAS WILSON & COMPANY, P.C.
Accountancy firm EIN2016-12-31810446334
2015 : MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$-152,762
Total unrealized appreciation/depreciation of assets2015-12-31$-152,762
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$849,563
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$576,420
Total income from all sources (including contributions)2015-12-31$3,566,560
Total loss/gain on sale of assets2015-12-31$91,778
Total of all expenses incurred2015-12-31$4,165,119
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$3,809,587
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$3,573,345
Value of total assets at end of year2015-12-31$1,543,177
Value of total assets at beginning of year2015-12-31$1,868,593
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$355,532
Total interest from all sources2015-12-31$1,803
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$52,396
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$130,988
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$1,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Assets. Other investments not covered elsewhere at end of year2015-12-31$1,910
Assets. Other investments not covered elsewhere at beginning of year2015-12-31$1,534
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$421,321
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$349,023
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$35,253
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$87,084
Administrative expenses (other) incurred2015-12-31$82,557
Liabilities. Value of operating payables at end of year2015-12-31$45,203
Liabilities. Value of operating payables at beginning of year2015-12-31$11,992
Total non interest bearing cash at end of year2015-12-31$2,393
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-598,559
Value of net assets at end of year (total assets less liabilities)2015-12-31$693,614
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$1,292,173
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$16,319
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$584,105
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$837,011
Interest earned on other investments2015-12-31$124
Income. Interest from corporate debt instruments2015-12-31$1,679
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$35,953
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$76,879
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$76,879
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$271,200
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$3,152,024
Employer contributions (assets) at end of year2015-12-31$6,979
Employer contributions (assets) at beginning of year2015-12-31$2,879
Income. Dividends from common stock2015-12-31$52,396
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$3,538,387
Asset. Corporate debt instrument debt (other) at end of year2015-12-31$25,050
Asset. Corporate debt instrument debt (other) at beginning of year2015-12-31$46,245
Contract administrator fees2015-12-31$125,668
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2015-12-31$537,764
Assets. Corporate common stocks other than exployer securities at beginning of year2015-12-31$868,792
Liabilities. Value of benefit claims payable at end of year2015-12-31$804,360
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$477,344
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Aggregate proceeds on sale of assets2015-12-31$1,014,908
Aggregate carrying amount (costs) on sale of assets2015-12-31$923,130
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31DOUGLAS WILSON & COMPANY, P.C.
Accountancy firm EIN2015-12-31810446334
2014 : MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$74,125
Total unrealized appreciation/depreciation of assets2014-12-31$74,125
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$576,420
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$346,038
Total income from all sources (including contributions)2014-12-31$3,353,051
Total loss/gain on sale of assets2014-12-31$7,596
Total of all expenses incurred2014-12-31$4,024,028
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$3,661,774
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$3,215,930
Value of total assets at end of year2014-12-31$1,868,593
Value of total assets at beginning of year2014-12-31$2,309,188
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$362,254
Total interest from all sources2014-12-31$9,170
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$46,230
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$139,125
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$1,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Assets. Other investments not covered elsewhere at end of year2014-12-31$1,534
Assets. Other investments not covered elsewhere at beginning of year2014-12-31$3,444
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$141,247
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$35,253
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$19,541
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$87,084
Administrative expenses (other) incurred2014-12-31$88,226
Liabilities. Value of operating payables at end of year2014-12-31$11,992
Liabilities. Value of operating payables at beginning of year2014-12-31$19,887
Total non interest bearing cash at end of year2014-12-31$0
Total non interest bearing cash at beginning of year2014-12-31$146,538
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-670,977
Value of net assets at end of year (total assets less liabilities)2014-12-31$1,292,173
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$1,963,150
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$18,552
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$837,011
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$675,034
Interest earned on other investments2014-12-31$6,362
Income. Interest from corporate debt instruments2014-12-31$2,808
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$76,879
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$524,386
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$524,386
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$268,618
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$3,074,683
Employer contributions (assets) at end of year2014-12-31$2,879
Employer contributions (assets) at beginning of year2014-12-31$15,210
Income. Dividends from common stock2014-12-31$46,230
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$3,393,156
Asset. Corporate debt instrument debt (other) at end of year2014-12-31$46,245
Asset. Corporate debt instrument debt (other) at beginning of year2014-12-31$68,435
Contract administrator fees2014-12-31$116,351
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2014-12-31$868,792
Assets. Corporate common stocks other than exployer securities at beginning of year2014-12-31$856,600
Liabilities. Value of benefit claims payable at end of year2014-12-31$477,344
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$326,151
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Aggregate proceeds on sale of assets2014-12-31$532,646
Aggregate carrying amount (costs) on sale of assets2014-12-31$525,050
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31DOUGLAS WILSON & COMPANY, P.C.
Accountancy firm EIN2014-12-31810446334
2013 : MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$94,689
Total unrealized appreciation/depreciation of assets2013-12-31$94,689
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$346,038
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$266,392
Total income from all sources (including contributions)2013-12-31$3,449,992
Total loss/gain on sale of assets2013-12-31$45,461
Total of all expenses incurred2013-12-31$3,495,877
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$3,179,642
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$3,274,419
Value of total assets at end of year2013-12-31$2,309,188
Value of total assets at beginning of year2013-12-31$2,275,427
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$316,235
Total interest from all sources2013-12-31$14,764
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$20,659
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$162,785
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$1,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Assets. Other investments not covered elsewhere at end of year2013-12-31$3,444
Assets. Other investments not covered elsewhere at beginning of year2013-12-31$4,298
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$19,541
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$13,936
Administrative expenses (other) incurred2013-12-31$33,830
Liabilities. Value of operating payables at end of year2013-12-31$19,887
Liabilities. Value of operating payables at beginning of year2013-12-31$10,435
Total non interest bearing cash at end of year2013-12-31$146,538
Total non interest bearing cash at beginning of year2013-12-31$950,753
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-45,885
Value of net assets at end of year (total assets less liabilities)2013-12-31$1,963,150
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$2,009,035
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Investment advisory and management fees2013-12-31$10,141
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$675,034
Interest earned on other investments2013-12-31$12,339
Income. Interest from corporate debt instruments2013-12-31$2,425
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$524,386
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$613,432
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$613,432
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$188,091
Asset value of US Government securities at beginning of year2013-12-31$60,340
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31Yes
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$3,274,419
Employer contributions (assets) at end of year2013-12-31$15,210
Employer contributions (assets) at beginning of year2013-12-31$3,339
Income. Dividends from common stock2013-12-31$20,659
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$2,991,551
Asset. Corporate debt instrument debt (other) at end of year2013-12-31$68,435
Asset. Corporate debt instrument debt (other) at beginning of year2013-12-31$69,913
Contract administrator fees2013-12-31$109,479
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2013-12-31$856,600
Assets. Corporate common stocks other than exployer securities at beginning of year2013-12-31$559,416
Liabilities. Value of benefit claims payable at end of year2013-12-31$326,151
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$255,957
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Aggregate proceeds on sale of assets2013-12-31$792,823
Aggregate carrying amount (costs) on sale of assets2013-12-31$747,362
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31DOUGLAS WILSON & CO, PC
Accountancy firm EIN2013-12-31810446334
2012 : MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$67,238
Total unrealized appreciation/depreciation of assets2012-12-31$67,238
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$267,356
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$265,396
Total income from all sources (including contributions)2012-12-31$3,159,050
Total loss/gain on sale of assets2012-12-31$-53,685
Total of all expenses incurred2012-12-31$3,031,780
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$2,657,336
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$3,103,428
Value of total assets at end of year2012-12-31$2,274,533
Value of total assets at beginning of year2012-12-31$2,145,303
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$374,444
Total interest from all sources2012-12-31$25,049
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$17,020
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Administrative expenses professional fees incurred2012-12-31$130,045
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$1,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Participant contributions at end of year2012-12-31$3,339
Participant contributions at beginning of year2012-12-31$1,078
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$17,340
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$26,771
Administrative expenses (other) incurred2012-12-31$65,149
Liabilities. Value of operating payables at end of year2012-12-31$11,399
Liabilities. Value of operating payables at beginning of year2012-12-31$18,869
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$127,270
Value of net assets at end of year (total assets less liabilities)2012-12-31$2,007,177
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$1,879,907
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Investment advisory and management fees2012-12-31$5,791
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$1,564,185
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$1,443,663
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$1,443,663
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$25,049
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$12,465
Asset value of US Government securities at end of year2012-12-31$130,253
Asset value of US Government securities at beginning of year2012-12-31$194,626
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$3,103,428
Income. Dividends from common stock2012-12-31$17,020
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$2,644,871
Contract administrator fees2012-12-31$173,459
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2012-12-31$559,416
Assets. Corporate common stocks other than exployer securities at beginning of year2012-12-31$479,165
Liabilities. Value of benefit claims payable at end of year2012-12-31$255,957
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$246,527
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Aggregate proceeds on sale of assets2012-12-31$576,259
Aggregate carrying amount (costs) on sale of assets2012-12-31$629,944
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31DOUGLAS WILSON & CO PC
Accountancy firm EIN2012-12-31810446334
2011 : MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$-22,989
Total unrealized appreciation/depreciation of assets2011-12-31$-22,989
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$265,396
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$284,718
Total income from all sources (including contributions)2011-12-31$3,330,559
Total loss/gain on sale of assets2011-12-31$-28,583
Total of all expenses incurred2011-12-31$3,030,434
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$2,457,831
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$3,352,166
Value of total assets at end of year2011-12-31$2,145,303
Value of total assets at beginning of year2011-12-31$1,821,436
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$572,603
Total interest from all sources2011-12-31$16,258
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$13,707
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$113,200
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$1,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Participant contributions at end of year2011-12-31$1,078
Participant contributions at beginning of year2011-12-31$1,215
Assets. Loans (other than to participants) at end of year2011-12-31$26,771
Assets. Loans (other than to participants) at beginning of year2011-12-31$3,599
Administrative expenses (other) incurred2011-12-31$45,643
Liabilities. Value of operating payables at end of year2011-12-31$18,869
Liabilities. Value of operating payables at beginning of year2011-12-31$24,089
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$300,125
Value of net assets at end of year (total assets less liabilities)2011-12-31$1,879,907
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$1,536,718
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$6,967
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$1,443,663
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$1,317,217
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$1,317,217
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$16,258
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$13,688
Asset value of US Government securities at end of year2011-12-31$194,626
Asset value of US Government securities at beginning of year2011-12-31$53,862
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
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
Contributions received in cash from employer2011-12-31$3,352,166
Income. Dividends from common stock2011-12-31$13,707
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$2,444,143
Contract administrator fees2011-12-31$406,793
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2011-12-31$479,165
Assets. Corporate common stocks other than exployer securities at beginning of year2011-12-31$445,543
Liabilities. Value of benefit claims payable at end of year2011-12-31$246,527
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$260,629
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
Aggregate carrying amount (costs) on sale of assets2011-12-31$28,583
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31DOUGLAS WILSON & COMPANY, P.C.
Accountancy firm EIN2011-12-31810446334
2010 : MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$22,400
Total unrealized appreciation/depreciation of assets2010-12-31$22,400
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$284,718
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$241,478
Total income from all sources (including contributions)2010-12-31$3,218,268
Total of all expenses incurred2010-12-31$3,266,234
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$2,725,946
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$3,173,542
Value of total assets at end of year2010-12-31$1,308,633
Value of total assets at beginning of year2010-12-31$1,826,162
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$540,288
Total interest from all sources2010-12-31$9,536
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$12,790
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2010-12-31$0
Administrative expenses professional fees incurred2010-12-31$137,049
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$1,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Participant contributions at end of year2010-12-31$1,215
Participant contributions at beginning of year2010-12-31$3,181
Administrative expenses (other) incurred2010-12-31$30,320
Liabilities. Value of operating payables at end of year2010-12-31$24,089
Liabilities. Value of operating payables at beginning of year2010-12-31$11,569
Total non interest bearing cash at beginning of year2010-12-31$1,243
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-47,966
Value of net assets at end of year (total assets less liabilities)2010-12-31$1,023,915
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$1,584,684
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$2,350
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$804,414
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$1,342,592
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$1,342,592
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$9,536
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$15,901
Asset value of US Government securities at end of year2010-12-31$53,862
Asset value of US Government securities at beginning of year2010-12-31$48,230
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$3,173,542
Income. Dividends from common stock2010-12-31$12,790
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$2,710,045
Contract administrator fees2010-12-31$370,569
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2010-12-31$445,543
Assets. Corporate common stocks other than exployer securities at beginning of year2010-12-31$429,551
Liabilities. Value of benefit claims payable at end of year2010-12-31$260,629
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$229,909
Assets. Value of buildings and other operty used in plan operation at end of year2010-12-31$3,599
Assets. Value of buildings and other operty used in plan operation at beginning of year2010-12-31$1,365
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
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31DOUGLAS WILSON & CO PC
Accountancy firm EIN2010-12-31810446334

Form 5500 Responses for MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST

2019: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01This submission is the final filingYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2016 form 5500 responses
2016-01-01Type of plan entityMulitple employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2015 form 5500 responses
2015-01-01Type of plan entityMulitple employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2014 form 5500 responses
2014-01-01Type of plan entityMulitple employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2013 form 5500 responses
2013-01-01Type of plan entityMulitple employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2012 form 5500 responses
2012-01-01Type of plan entityMulitple employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2011 form 5500 responses
2011-01-01Type of plan entityMulitple employer plan
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: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2010 form 5500 responses
2010-01-01Type of plan entityMulitple employer plan
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: MONTANA DENTAL ASSOCIATION GROUP BENEFITS TRUST 2009 form 5500 responses
2009-01-01Type of plan entityMulitple employer plan
2009-01-01This submission is the final filingNo
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

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number06-1227840
Policy instance 1
Insurance contract or identification number06-1227840
Number of Individuals Covered256
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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 $16,957
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker name
EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract numberG1018-2014R2
Policy instance 2
Insurance contract or identification numberG1018-2014R2
Number of Individuals Covered279
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $267,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number06-1227840
Policy instance 1
Insurance contract or identification number06-1227840
Number of Individuals Covered251
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $11,933
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,200
Insurance broker organization code?3
Insurance broker nameLEAVITT GREAT WEST INSURANCE
EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract numberG1018-2014R2
Policy instance 2
Insurance contract or identification numberG1018-2014R2
Number of Individuals Covered271
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $248,682
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number06-1227840
Policy instance 1
Insurance contract or identification number06-1227840
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,595
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,595
Insurance broker organization code?3
Insurance broker nameMOUNTAIN WEST BENEFITS SOLUTIONS
EMBS-MUNCH REINSURANCE (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number
Policy instance 2
Number of Individuals Covered262
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $185,361
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number06-1227840
Policy instance 1
Insurance contract or identification number06-1227840
Number of Individuals Covered247
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,285
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,285
Insurance broker organization code?3
Insurance broker nameMOUNTAIN WEST BENEFITS SOLUTIONS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number06-1227840
Policy instance 1
Insurance contract or identification number06-1227840
Number of Individuals Covered244
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,340
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MONTANA (National Association of Insurance Commissioners NAIC id number: 53686 )
Policy contract number566565
Policy instance 2
Insurance contract or identification number566565
Number of Individuals Covered605
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number06-1227840
Policy instance 1
Insurance contract or identification number06-1227840
Number of Individuals Covered318
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,149
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MONTANA (National Association of Insurance Commissioners NAIC id number: 53686 )
Policy contract number566565
Policy instance 2
Insurance contract or identification number566565
Number of Individuals Covered263
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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