DELTA DENTAL OF PUERTO RICO, INC. LIFE AND AD&D, AND LTD 401k Plan overview

DELTA DENTAL OF PUERTO RICO, INC. LIFE AND AD&D, AND LTD Benefits

401k Sponsoring company profile

Company Name:	DELTA DENTAL OF PUERTO RIRCO, INC.
Employer identification number (EIN):	680652604
NAIC Classification:	524150

Form 5500 Filing Information

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2023-08-01

Plan Statistics for DELTA DENTAL OF PUERTO RICO, INC. LIFE AND AD&D, AND LTD

Measure	Date	Value
2023: DELTA DENTAL OF PUERTO RICO, INC. LIFE AND AD&D, AND LTD 2023 401k membership
Total participants, beginning-of-year	2023-08-01	108
Total number of active participants reported on line 7a of the Form 5500	2023-08-01	108
Total of all active and inactive participants	2023-08-01	108
Total participants	2023-08-01	108

Form 5500 Responses for DELTA DENTAL OF PUERTO RICO, INC. LIFE AND AD&D, AND LTD

Insurance Providers Used on plan

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• DELTA DENTAL OF KANSAS, INC. 401(K) RETIREMENT PLAN [EIN = 480793267]
• DELTA DENTAL OF WISCONSIN, INC. EMPLOYEE [EIN = 396094742]
• DELTA DENTAL PLAN OF MICHIGAN, INC. RETIREMENT INCOME PLAN [EIN = 381791480]
• DELTA DENTAL PLAN OF COLORADO WELFARE BENEFIT PLAN [EIN = 840568337]
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• DELTA DENTAL 401(K) RETIREMENT SAVINGS PLAN [EIN = 820299431]
• DELTA DENTAL OF ARIZONA 401(K) PLAN [EIN = 860274899]
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• DELTA DENTAL OF TENNESSEE 401K PROFIT SHARING PLAN [EIN = 620812197]
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• DELTA DENTAL [EIN = 043535072]
• DELTA DENTAL OF RI [EIN = 050398907]
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• DELTA DENTAL [EIN = 980132585]
• DELTA DENTAL OF IDAHO [EIN = 300793947]
• DELTA DENTAL PLAN OF COLORADO WELFARE BENEFIT PLAN [EIN = 834416613]
• DELTA DENTAL OF COLORADO SAVINGS AND RETIREMENT PLAN [EIN = 834416613]
• DELTA DENTAL OF NJ INC [EIN = 812857619]
• DELTA DENTAL [EIN = 311421130]
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• DELTA DENTAL - PREVENTIVE [EIN = 390233059]
• DELTA DENTAL - TRADITIONAL [EIN = 390233059]
• DELTA DENTAL OF VIRGINIA [EIN = 823614228]
• DELTA DENTAL [EIN = 462751352]
• DELTA DENTAL OF KENTUCKY, INC. 401(K) PLAN [EIN = 610659432]
• DELTA DENTAL [EIN = 882681819]

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