401k Plan data: SDDS AHP MEDICAL PLAN plan

SDDS AHP MEDICAL PLAN 401k Plan overview

Plan Name	SDDS AHP MEDICAL PLAN
Plan identification number	501

SDDS AHP MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	SELECT distinct(Description) AS Description FROM 401k_benefit_codes LEFT JOIN 401k_benefit_code_description ON BenefitCode=Code COLLATE utf8_unicode_ci WHERE EIN='916058413' AND PlanID='501'

401k Sponsoring company profile

SPOKANE DISTRICT DENTAL SOCIETY has sponsored the creation of one or more 401k plans.

Company Name: SPOKANE DISTRICT DENTAL SOCIETY

Employer identification number (EIN): 916058413

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SDDS AHP MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01 LACY MCCORMICK 2024-08-14
501 2022-01-01 LACY MCCORMICK 2024-08-14
501 2021-01-01 LACY MCCORMICK 2024-08-14
501 2020-01-01 LACY MCCORMICK 2024-08-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2023-01-01	LACY MCCORMICK	2024-08-14
501	2022-01-01	LACY MCCORMICK	2024-08-14
501	2021-01-01	LACY MCCORMICK	2024-08-14
501	2020-01-01	LACY MCCORMICK	2024-08-14

Insurance Providers Used on plan

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

8554100

Policy instance

Insurance contract or identification number	8554100
Number of Individuals Covered	217
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $893,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4173900

Policy instance

Insurance contract or identification number	4173900
Number of Individuals Covered	111
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $336,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

8554100

Policy instance

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4172300

Policy instance

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

8554100

Policy instance

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4172300

Policy instance

GROUP HEALTH OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 47055 )

Policy contract number

8554100

Policy instance

Insurance contract or identification number	8554100
Number of Individuals Covered	25
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $84,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

4172300

Policy instance

Insurance contract or identification number	4172300
Number of Individuals Covered	46
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	SPOKANE DISTRICT DENTAL SOCIETY
Employer identification number (EIN):	916058413
NAIC Classification:	621210
NAIC Description:	Offices of Dentists