401k Plan data: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN plan

PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 401k Plan overview

Plan Name	PRIMARY HEALTH CARE PARTNERS DENTAL PLAN
Plan identification number	502

PRIMARY HEALTH CARE PARTNERS DENTAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20. Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

PCHP-MEDICAL SERVICES ORGANAZATION LLP has sponsored the creation of one or more 401k plans.

Company Name: PCHP-MEDICAL SERVICES ORGANAZATION LLP

Employer identification number (EIN): 030362571

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRIMARY HEALTH CARE PARTNERS DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2014-01-01 SHERYL TROVILLE
502 2014-01-01 SHERYL TROVILLE
502 2012-01-01 SHERYL TROVILLE
502 2011-01-01 SHERYL TROVILLE
502 2010-01-01 SHERYL TROVILLE
502 2009-01-01 SHERYL TROVILLE

Plan id#	Filing Submission Date	Name of Administrator
502	2014-01-01	SHERYL TROVILLE
502	2014-01-01	SHERYL TROVILLE
502	2012-01-01	SHERYL TROVILLE
502	2011-01-01	SHERYL TROVILLE
502	2010-01-01	SHERYL TROVILLE
502	2009-01-01	SHERYL TROVILLE

Plan Statistics for PRIMARY HEALTH CARE PARTNERS DENTAL PLAN

401k plan membership statisitcs for PRIMARY HEALTH CARE PARTNERS DENTAL PLAN

Measure Date Value
2014: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 99
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 0
Total of all active and inactive participants 2014-01-01 99
2012: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 92
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 85
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 0
Total of all active and inactive participants 2012-01-01 85
2011: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 92
Total of all active and inactive participants 2011-01-01 92
Total participants 2011-01-01 92
2010: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 115
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 111
Total of all active and inactive participants 2010-01-01 111
Total participants 2010-01-01 111
2009: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 115
Total of all active and inactive participants 2009-01-01 115
Total participants 2009-01-01 115

Measure	Date	Value
2014: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	99
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	0
Total of all active and inactive participants	2014-01-01	99
2012: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	92
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	85
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	0
Total of all active and inactive participants	2012-01-01	85
2011: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	92
Total of all active and inactive participants	2011-01-01	92
Total participants	2011-01-01	92
2010: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	115
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	111
Total of all active and inactive participants	2010-01-01	111
Total participants	2010-01-01	111
2009: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	115
Total of all active and inactive participants	2009-01-01	115
Total participants	2009-01-01	115

Form 5500 Responses for PRIMARY HEALTH CARE PARTNERS DENTAL PLAN

2014: PRIMARY HEALTH CARE PARTNERS DENTAL 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 benefit arrangement – Insurance	Yes
2012: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
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 benefit arrangement – Insurance	Yes
2011: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: PRIMARY HEALTH CARE PARTNERS DENTAL PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0101554

Policy instance

Insurance contract or identification number	0101554
Number of Individuals Covered	201
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,230
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
Welfare Benefit Premiums Paid to Carrier	USD $89,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,230
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	HICKOK & BOARDMAN FINANCIAL

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0101554

Policy instance

Insurance contract or identification number	0101554
Number of Individuals Covered	172
Total amount of commissions paid to insurance broker	USD $2,904
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $70,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
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
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
Commission paid to Insurance Broker	USD $2,904
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	HICKOK & BOARDMAN FINANCIAL

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0101554

Policy instance

Insurance contract or identification number	0101554
Number of Individuals Covered	188
Total amount of commissions paid to insurance broker	USD $3,103
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $79,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

0101554

Policy instance

Insurance contract or identification number	0101554
Total amount of commissions paid to insurance broker	USD $3,271
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $91,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,271
Insurance broker organization code?	3
Insurance broker name	HICKOK & BOARDMAN FINANCIAL

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Company Name:	PCHP-MEDICAL SERVICES ORGANAZATION LLP
Employer identification number (EIN):	030362571
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)