401k Plan data: LEE AND HAYES EMPLOYEE DENTAL PLAN plan

LEE AND HAYES EMPLOYEE DENTAL PLAN 401k Plan overview

Plan Name	LEE AND HAYES EMPLOYEE DENTAL PLAN
Plan identification number	502

LEE AND HAYES EMPLOYEE DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

LEE & HAYES, PLLC has sponsored the creation of one or more 401k plans.

Company Name: LEE & HAYES, PLLC

Employer identification number (EIN): 911662955

NAIC Classification: 541110
NAIC Description: Offices of Lawyers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEE AND HAYES EMPLOYEE DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2018-01-01 SHELBY NESS 2019-07-30
502 2017-01-01
502 2016-01-01
502 2015-01-01 SHELBY NESS
502 2014-01-01 SHELBY NESS

Plan Statistics for LEE AND HAYES EMPLOYEE DENTAL PLAN

401k plan membership statisitcs for LEE AND HAYES EMPLOYEE DENTAL PLAN

Measure Date Value
2018: LEE AND HAYES EMPLOYEE DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 131
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 131
Number of employers contributing to the scheme 2018-01-01 0
2017: LEE AND HAYES EMPLOYEE DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 141
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 0
Total of all active and inactive participants 2017-01-01 141
2016: LEE AND HAYES EMPLOYEE DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 143
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 0
Total of all active and inactive participants 2016-01-01 143
2015: LEE AND HAYES EMPLOYEE DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 149
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 0
Total of all active and inactive participants 2015-01-01 149
2014: LEE AND HAYES EMPLOYEE DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 134
Total of all active and inactive participants 2014-01-01 134
Total participants 2014-01-01 134

Measure	Date	Value
2018: LEE AND HAYES EMPLOYEE DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	131
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	131
Number of employers contributing to the scheme	2018-01-01	0
2017: LEE AND HAYES EMPLOYEE DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	141
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	0
Total of all active and inactive participants	2017-01-01	141
2016: LEE AND HAYES EMPLOYEE DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	143
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	0
Total of all active and inactive participants	2016-01-01	143
2015: LEE AND HAYES EMPLOYEE DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	149
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	0
Total of all active and inactive participants	2015-01-01	149
2014: LEE AND HAYES EMPLOYEE DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	134
Total of all active and inactive participants	2014-01-01	134
Total participants	2014-01-01	134

Form 5500 Responses for LEE AND HAYES EMPLOYEE DENTAL PLAN

2018: LEE AND HAYES EMPLOYEE DENTAL PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: LEE AND HAYES EMPLOYEE DENTAL PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: LEE AND HAYES EMPLOYEE DENTAL 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 benefit arrangement – Insurance	Yes
2015: LEE AND HAYES EMPLOYEE DENTAL 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 benefit arrangement – Insurance	Yes
2014: LEE AND HAYES EMPLOYEE DENTAL PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )

Policy contract number

1354

Policy instance

Insurance contract or identification number	1354
Number of Individuals Covered	306
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $7,239
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $7,239
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )

Policy contract number

1354

Policy instance

Insurance contract or identification number	1354
Number of Individuals Covered	337
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $8,018
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $8,018
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	ALLIANT INSURANCE SERVICES, INC.

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )

Policy contract number

1354

Policy instance

Insurance contract or identification number	1354
Number of Individuals Covered	348
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $6,380
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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?	Yes
Commission paid to Insurance Broker	USD $3,424
Insurance broker organization code?	3
Insurance broker name	MOLONEY AND ONEIL LIFE INC.

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 74341 )

Policy contract number

1354

Policy instance

Insurance contract or identification number	1354
Number of Individuals Covered	134
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,094
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
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 $2,802
Insurance broker organization code?	3
Insurance broker name	CORKERY AND JONES BENEFITS INC

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Company Name:	LEE & HAYES, PLLC
Employer identification number (EIN):	911662955
NAIC Classification:	541110
NAIC Description:	Offices of Lawyers

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2018-01-01	SHELBY NESS	2019-07-30
502	2017-01-01
502	2016-01-01
502	2015-01-01	SHELBY NESS
502	2014-01-01	SHELBY NESS