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MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 401k Plan overview

Plan NameMEVION MEDICAL SYSTEMS, INC. DENTAL PLAN
Plan identification number 502

MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Dental

401k Sponsoring company profile

MEVION MEDICAL SYSTEMS INC. has sponsored the creation of one or more 401k plans.

Company Name:MEVION MEDICAL SYSTEMS INC.
Employer identification number (EIN):200794350
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01
5022021-01-01ERICA CONNOLLY2022-05-17
5022020-02-01ERICA CONNOLLY2021-07-26
5022019-02-01VICTORIA MASTRO ALLEN2020-08-14
5022018-02-01VICTORIA MASTRO ALLEN2019-11-13
5022017-02-01
5022016-02-01
5022015-02-01
5022014-02-01SHERRI HODGSON
5022013-02-01

Plan Statistics for MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN

401k plan membership statisitcs for MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN

Measure Date Value
2022: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01111
Total number of active participants reported on line 7a of the Form 55002022-01-01131
Number of retired or separated participants receiving benefits2022-01-015
Number of other retired or separated participants entitled to future benefits2022-01-0130
Total of all active and inactive participants2022-01-01166
2021: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01120
Total number of active participants reported on line 7a of the Form 55002021-01-01127
Number of retired or separated participants receiving benefits2021-01-014
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01131
Number of employers contributing to the scheme2021-01-010
2020: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-01124
Total number of active participants reported on line 7a of the Form 55002020-02-01120
Number of retired or separated participants receiving benefits2020-02-016
Number of other retired or separated participants entitled to future benefits2020-02-010
Total of all active and inactive participants2020-02-01126
Number of employers contributing to the scheme2020-02-010
2019: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-02-01108
Total number of active participants reported on line 7a of the Form 55002019-02-01112
Number of retired or separated participants receiving benefits2019-02-010
Number of other retired or separated participants entitled to future benefits2019-02-010
Total of all active and inactive participants2019-02-01112
Number of employers contributing to the scheme2019-02-010
2018: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-01118
Total number of active participants reported on line 7a of the Form 55002018-02-01108
Number of retired or separated participants receiving benefits2018-02-011
Number of other retired or separated participants entitled to future benefits2018-02-010
Total of all active and inactive participants2018-02-01109
Number of employers contributing to the scheme2018-02-010
2017: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-02-01118
Total number of active participants reported on line 7a of the Form 55002017-02-01118
Number of retired or separated participants receiving benefits2017-02-010
Number of other retired or separated participants entitled to future benefits2017-02-010
Total of all active and inactive participants2017-02-01118
2016: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-01153
Total number of active participants reported on line 7a of the Form 55002016-02-01166
Number of retired or separated participants receiving benefits2016-02-010
Number of other retired or separated participants entitled to future benefits2016-02-010
Total of all active and inactive participants2016-02-01166
2015: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-01155
Total number of active participants reported on line 7a of the Form 55002015-02-01153
Number of retired or separated participants receiving benefits2015-02-010
Number of other retired or separated participants entitled to future benefits2015-02-010
Total of all active and inactive participants2015-02-01153
2014: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-01136
Total number of active participants reported on line 7a of the Form 55002014-02-01153
Number of retired or separated participants receiving benefits2014-02-010
Number of other retired or separated participants entitled to future benefits2014-02-010
Total of all active and inactive participants2014-02-01153
2013: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-01113
Total number of active participants reported on line 7a of the Form 55002013-02-01136
Number of retired or separated participants receiving benefits2013-02-010
Number of other retired or separated participants entitled to future benefits2013-02-010
Total of all active and inactive participants2013-02-01136

Form 5500 Responses for MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN

2022: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – InsuranceYes
2019: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2018: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes
2017: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Submission has been amendedNo
2017-02-01This submission is the final filingNo
2017-02-01This return/report is a short plan year return/report (less than 12 months)No
2017-02-01Plan is a collectively bargained planNo
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan benefit arrangement – InsuranceYes
2016: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Submission has been amendedNo
2016-02-01This submission is the final filingNo
2016-02-01This return/report is a short plan year return/report (less than 12 months)No
2016-02-01Plan is a collectively bargained planNo
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan benefit arrangement – InsuranceYes
2015: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Submission has been amendedNo
2015-02-01This submission is the final filingNo
2015-02-01This return/report is a short plan year return/report (less than 12 months)No
2015-02-01Plan is a collectively bargained planNo
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan benefit arrangement – InsuranceYes
2014: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Submission has been amendedNo
2014-02-01This submission is the final filingNo
2014-02-01This return/report is a short plan year return/report (less than 12 months)No
2014-02-01Plan is a collectively bargained planNo
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan benefit arrangement – InsuranceYes
2013: MEVION MEDICAL SYSTEMS, INC. DENTAL PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01First time form 5500 has been submittedYes
2013-02-01Submission has been amendedNo
2013-02-01This submission is the final filingNo
2013-02-01This return/report is a short plan year return/report (less than 12 months)No
2013-02-01Plan is a collectively bargained planNo
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number0136380001
Policy instance 1
Insurance contract or identification number0136380001
Number of Individuals Covered360
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $9,217
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $189,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,701
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number13638
Policy instance 1
Insurance contract or identification number13638
Number of Individuals Covered351
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,361
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $182,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,361
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number13638
Policy instance 1
Insurance contract or identification number13638
Number of Individuals Covered344
Insurance policy start date2020-02-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $7,616
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $169,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,616
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number13638
Policy instance 1
Insurance contract or identification number13638
Number of Individuals Covered326
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $5,311
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $153,596
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,311
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number13638
Policy instance 1
Insurance contract or identification number13638
Number of Individuals Covered303
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $5,100
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $147,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,100
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF MASSACHUSETTS (National Association of Insurance Commissioners NAIC id number: 52060 )
Policy contract number13638
Policy instance 1
Insurance contract or identification number13638
Number of Individuals Covered320
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $5,667
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $181,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,667
Insurance broker organization code?3
Insurance broker nameINTEGRATED INSURANCE SOLUTIONS
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number8021645
Policy instance 1
Insurance contract or identification number8021645
Number of Individuals Covered372
Insurance policy start date2013-02-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $5,608
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $5,608
Insurance broker organization code?3
Insurance broker nameINTEGRATED INSURANCE SOLUTIONS

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