401k Plan data: CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN plan

CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 401k Plan overview

Plan Name	CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN
Plan identification number	002

CHILDREN'S DENTAL GROUP 401(K) RETIREMENT 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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

SIERRA PACIFIC DENTAL CONSULTANTS, LLC has sponsored the creation of one or more 401k plans.

Company Name: SIERRA PACIFIC DENTAL CONSULTANTS, LLC

Employer identification number (EIN): 954769912

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Additional information about SIERRA PACIFIC DENTAL CONSULTANTS, LLC

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: 199930010068

More information about SIERRA PACIFIC DENTAL CONSULTANTS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2018-01-01
002 2017-01-01 SAMUEL H. GRUENBAUM 2020-04-17
002 2016-01-01
002 2015-01-01

Plan Statistics for CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN

401k plan membership statisitcs for CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN

Measure Date Value
2017: CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 225
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 3
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 68
Total of all active and inactive participants 2017-01-01 71
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 71
Number of participants with account balances 2017-01-01 68
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 13
2016: CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 226
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 169
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 15
Total of all active and inactive participants 2016-01-01 184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 184
Number of participants with account balances 2016-01-01 82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 10
2015: CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 230
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 175
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 32
Total of all active and inactive participants 2015-01-01 207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 207
Number of participants with account balances 2015-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 1

Measure	Date	Value
2017: CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	225
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	3
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	68
Total of all active and inactive participants	2017-01-01	71
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	71
Number of participants with account balances	2017-01-01	68
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	13
2016: CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	226
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	169
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	15
Total of all active and inactive participants	2016-01-01	184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	184
Number of participants with account balances	2016-01-01	82
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	10
2015: CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	230
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	175
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	32
Total of all active and inactive participants	2015-01-01	207
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	207
Number of participants with account balances	2015-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	1

Financial Data on CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN

Measure	Date	Value
2017 : CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total transfer of assets to this plan	2017-12-31	$15,240
Total transfer of assets from this plan	2017-12-31	$153,645
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$725,028
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$606,719
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$595,893
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$271,212
Value of total assets at end of year	2017-12-31	$3,677,590
Value of total assets at beginning of year	2017-12-31	$3,697,686
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$10,826
Total interest from all sources	2017-12-31	$862
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2017-12-31	$0
Administrative expenses professional fees incurred	2017-12-31	$10,826
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$369,769
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$214,994
Participant contributions at end of year	2017-12-31	$13,437
Participant contributions at beginning of year	2017-12-31	$17,959
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$7,471
Total non interest bearing cash at end of year	2017-12-31	$7,878
Total non interest bearing cash at beginning of year	2017-12-31	$7,878
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$118,309
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$3,677,590
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$3,697,686
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$3,571,891
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$3,567,828
Interest on participant loans	2017-12-31	$862
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$39,705
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$36,974
Net investment gain/loss from pooled separate accounts	2017-12-31	$452,954
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$48,747
Employer contributions (assets) at end of year	2017-12-31	$44,679
Employer contributions (assets) at beginning of year	2017-12-31	$67,047
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$595,893
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	LODGEN LACHER GOLDITCH SARDI SAUNDE
Accountancy firm EIN	2017-12-31	954346929
2016 : CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total transfer of assets to this plan	2016-12-31	$40,734
Total transfer of assets from this plan	2016-12-31	$107,578
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$635,156
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$294,149
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$281,764
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$397,562
Value of total assets at end of year	2016-12-31	$3,697,686
Value of total assets at beginning of year	2016-12-31	$3,423,523
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$12,385
Total interest from all sources	2016-12-31	$1,184
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$12,385
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$342,353
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$330,515
Participant contributions at end of year	2016-12-31	$17,959
Participant contributions at beginning of year	2016-12-31	$22,536
Other income not declared elsewhere	2016-12-31	$46
Total non interest bearing cash at end of year	2016-12-31	$7,878
Total non interest bearing cash at beginning of year	2016-12-31	$7,831
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$341,007
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$3,697,686
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$3,423,523
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$3,567,828
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$3,277,444
Interest on participant loans	2016-12-31	$1,184
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$36,974
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$34,171
Net investment gain/loss from pooled separate accounts	2016-12-31	$236,364
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$67,047
Employer contributions (assets) at end of year	2016-12-31	$67,047
Employer contributions (assets) at beginning of year	2016-12-31	$81,541
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$281,764
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	LODGEN LACHER GOLDITCH SARDI SAUNDE
Accountancy firm EIN	2016-12-31	954346929
2015 : CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total transfer of assets to this plan	2015-12-31	$3,076
Total transfer of assets from this plan	2015-12-31	$3
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$361,157
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$491,168
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$478,741
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$406,998
Value of total assets at end of year	2015-12-31	$3,423,523
Value of total assets at beginning of year	2015-12-31	$3,550,461
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$12,427
Total interest from all sources	2015-12-31	$1,122
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$12,427
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$355,047
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$325,457
Participant contributions at end of year	2015-12-31	$22,536
Participant contributions at beginning of year	2015-12-31	$23,009
Total non interest bearing cash at end of year	2015-12-31	$7,831
Total non interest bearing cash at beginning of year	2015-12-31	$2,263
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-130,011
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$3,423,523
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$3,550,461
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$3,277,444
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$3,395,552
Interest on participant loans	2015-12-31	$1,048
Interest earned on other investments	2015-12-31	$74
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$34,171
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$31,079
Net investment gain/loss from pooled separate accounts	2015-12-31	$-46,963
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$81,541
Employer contributions (assets) at end of year	2015-12-31	$81,541
Employer contributions (assets) at beginning of year	2015-12-31	$98,558
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$478,741
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	LODGEN LACHER GOLDITCH SARDI SAUNDE
Accountancy firm EIN	2015-12-31	954346929

Form 5500 Responses for CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN

2017: CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CHILDREN'S DENTAL GROUP 401(K) RETIREMENT PLAN 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 funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

26745

Policy instance

Insurance contract or identification number	26745
Number of Individuals Covered	74
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $14,716
Total amount of fees paid to insurance company	USD $3,674
Are there contracts with allocated funds for individual policies?	0
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

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

26745

Policy instance

Insurance contract or identification number	26745
Number of Individuals Covered	136
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $13,683
Total amount of fees paid to insurance company	USD $2,017
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 $13,683
Insurance broker organization code?	3
Amount paid for insurance broker fees	2017
Additional information about fees paid to insurance broker	ADMINISTRATIVE REIMBURSEMENT
Insurance broker name	KRAVITZ INC.

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Company Name:	SIERRA PACIFIC DENTAL CONSULTANTS, LLC
Employer identification number (EIN):	954769912
NAIC Classification:	621210
NAIC Description:	Offices of Dentists

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	199930010068

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2018-01-01
002	2017-01-01	SAMUEL H. GRUENBAUM	2020-04-17
002	2016-01-01
002	2015-01-01