401k Plan data: ALSEA BAY DENTAL CLINIC 401(K) PLAN plan

ALSEA BAY DENTAL CLINIC 401(K) PLAN 401k Plan overview

Plan Name	ALSEA BAY DENTAL CLINIC 401(K) PLAN
Plan identification number	001

ALSEA BAY DENTAL CLINIC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

ALSEA BAY DENTAL CLINIC has sponsored the creation of one or more 401k plans.

Company Name: ALSEA BAY DENTAL CLINIC

Employer identification number (EIN): 931307785

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALSEA BAY DENTAL CLINIC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 WILLIAM HARTSELL 2023-10-16
001 2021-01-01 WILLIAM HARTSELL 2022-07-26
001 2020-01-01 WILLIAM HARTSELL 2021-09-30 WILLIAM HARTSELL 2021-09-30
001 2019-01-01 WILLIAM HARTSELL 2020-10-13 WILLIAM HARTSELL 2020-10-13
001 2018-01-01 WILLIAM HARTSELL 2019-10-14 WILLIAM HARTSELL 2019-10-14
001 2017-01-01 WILLIAM S HARTSELL 2018-07-18 WILLIAM S HARTSELL 2018-07-18
001 2016-01-01 WILLIAM S HARTSELL 2017-07-25 WILLIAM S HARTSELL 2017-07-25
001 2015-01-01 WILLIAM S HARTSELL 2016-07-21 WILLIAM S HARTSELL 2016-07-21
001 2014-01-01 WILLIAM HARTSELL
001 2013-01-01 WILLIAM HARTSELL WILLIAM HARTSELL 2014-06-17
001 2012-01-01 WILLIAM HARTSELL WILLIAM HARTSELL 2013-07-05
001 2011-01-01 WILLIAM HARTSELL
001 2010-01-01 WILLIAM HARTSELL 2011-10-12

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	WILLIAM HARTSELL	2023-10-16
001	2021-01-01	WILLIAM HARTSELL	2022-07-26
001	2020-01-01	WILLIAM HARTSELL	2021-09-30	WILLIAM HARTSELL	2021-09-30
001	2019-01-01	WILLIAM HARTSELL	2020-10-13	WILLIAM HARTSELL	2020-10-13
001	2018-01-01	WILLIAM HARTSELL	2019-10-14	WILLIAM HARTSELL	2019-10-14
001	2017-01-01	WILLIAM S HARTSELL	2018-07-18	WILLIAM S HARTSELL	2018-07-18
001	2016-01-01	WILLIAM S HARTSELL	2017-07-25	WILLIAM S HARTSELL	2017-07-25
001	2015-01-01	WILLIAM S HARTSELL	2016-07-21	WILLIAM S HARTSELL	2016-07-21
001	2014-01-01	WILLIAM HARTSELL
001	2013-01-01	WILLIAM HARTSELL		WILLIAM HARTSELL	2014-06-17
001	2012-01-01	WILLIAM HARTSELL		WILLIAM HARTSELL	2013-07-05
001	2011-01-01	WILLIAM HARTSELL
001	2010-01-01	WILLIAM HARTSELL	2011-10-12

Plan Statistics for ALSEA BAY DENTAL CLINIC 401(K) PLAN

401k plan membership statisitcs for ALSEA BAY DENTAL CLINIC 401(K) PLAN

Measure Date Value
2014: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 7
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 2
Total of all active and inactive participants 2014-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 9
Number of participants with account balances 2014-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 7
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 9
Number of participants with account balances 2013-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 6
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 2
Total of all active and inactive participants 2012-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 8
Number of participants with account balances 2012-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 7
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 2
Total of all active and inactive participants 2011-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 9
Number of participants with account balances 2011-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2014: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	7
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	2
Total of all active and inactive participants	2014-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	9
Number of participants with account balances	2014-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	7
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	9
Number of participants with account balances	2013-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	6
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	2
Total of all active and inactive participants	2012-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	8
Number of participants with account balances	2012-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	7
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	2
Total of all active and inactive participants	2011-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	9
Number of participants with account balances	2011-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on ALSEA BAY DENTAL CLINIC 401(K) PLAN

Measure	Date	Value
2014 : ALSEA BAY DENTAL CLINIC 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$102,779
Expenses. Total of all expenses incurred	2014-12-31	$419
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$832,427
Total plan assets at beginning of year	2014-12-31	$730,067
Value of fidelity bond covering the plan	2014-12-31	$15,000
Total contributions received or receivable from participants	2014-12-31	$62,891
Expenses. Other expenses not covered elsewhere	2014-12-31	$419
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$29,672
Net income (gross income less expenses)	2014-12-31	$102,360
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$832,427
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$730,067
Assets. Value of participant loans	2014-12-31	$10,367
Total contributions received or receivable from employer(s)	2014-12-31	$10,216
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
2013 : ALSEA BAY DENTAL CLINIC 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$209,981
Expenses. Total of all expenses incurred	2013-12-31	$814
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$730,067
Total plan assets at beginning of year	2013-12-31	$520,900
Value of fidelity bond covering the plan	2013-12-31	$15,000
Total contributions received or receivable from participants	2013-12-31	$65,595
Expenses. Other expenses not covered elsewhere	2013-12-31	$814
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$133,749
Net income (gross income less expenses)	2013-12-31	$209,167
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$730,067
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$520,900
Assets. Value of participant loans	2013-12-31	$10,367
Total contributions received or receivable from employer(s)	2013-12-31	$10,637
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
2012 : ALSEA BAY DENTAL CLINIC 401(K) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$123,641
Expenses. Total of all expenses incurred	2012-12-31	$4,196
Benefits paid (including direct rollovers)	2012-12-31	$4,103
Total plan assets at end of year	2012-12-31	$520,900
Total plan assets at beginning of year	2012-12-31	$401,455
Value of fidelity bond covering the plan	2012-12-31	$15,000
Total contributions received or receivable from participants	2012-12-31	$52,752
Expenses. Other expenses not covered elsewhere	2012-12-31	$93
Contributions received from other sources (not participants or employers)	2012-12-31	$2,596
Other income received	2012-12-31	$50,549
Net income (gross income less expenses)	2012-12-31	$119,445
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$520,900
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$401,455
Assets. Value of participant loans	2012-12-31	$10,367
Total contributions received or receivable from employer(s)	2012-12-31	$17,744
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
2011 : ALSEA BAY DENTAL CLINIC 401(K) PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$61,303
Expenses. Total of all expenses incurred	2011-12-31	$3,585
Benefits paid (including direct rollovers)	2011-12-31	$1,620
Total plan assets at end of year	2011-12-31	$401,455
Total plan assets at beginning of year	2011-12-31	$343,737
Value of fidelity bond covering the plan	2011-12-31	$15,000
Total contributions received or receivable from participants	2011-12-31	$54,594
Expenses. Other expenses not covered elsewhere	2011-12-31	$1,965
Contributions received from other sources (not participants or employers)	2011-12-31	$14,742
Other income received	2011-12-31	$-11,085
Net income (gross income less expenses)	2011-12-31	$57,718
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$401,455
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$343,737
Assets. Value of participant loans	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$3,052
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0

Form 5500 Responses for ALSEA BAY DENTAL CLINIC 401(K) PLAN

2014: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
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 funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ALSEA BAY DENTAL CLINIC 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-824953

Policy instance

Insurance contract or identification number	GA-824953
Number of Individuals Covered	8
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,946
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,946
Insurance broker organization code?	3
Insurance broker name	LPL FINANCIAL CORPORATION

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-824953

Policy instance

Insurance contract or identification number	GA-824953
Number of Individuals Covered	8
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,245
Total amount of fees paid to insurance company	USD $54
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,245
Insurance broker organization code?	3
Amount paid for insurance broker fees	54
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker name	LPL FINANCIAL LLC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-824953

Policy instance

Insurance contract or identification number	GA-824953
Number of Individuals Covered	6
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,719
Total amount of fees paid to insurance company	USD $74
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,719
Insurance broker organization code?	3
Amount paid for insurance broker fees	74
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker name	LPL FINANCIAL LLC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-824953

Policy instance

Insurance contract or identification number	GA-824953
Number of Individuals Covered	9
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $884
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ALSEA BAY DENTAL CLINIC
Employer identification number (EIN):	931307785
NAIC Classification:	621210
NAIC Description:	Offices of Dentists