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ADA WEST DERMATOLOGY, P.C. DENTAL PLAN 401k Plan overview

Plan NameADA WEST DERMATOLOGY, P.C. DENTAL PLAN
Plan identification number 502

ADA WEST DERMATOLOGY, P.C. DENTAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Dental

401k Sponsoring company profile

ADA WEST DERMATOLOGY, P.C. has sponsored the creation of one or more 401k plans.

Company Name:ADA WEST DERMATOLOGY, P.C.
Employer identification number (EIN):203276415
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ADA WEST DERMATOLOGY, P.C. DENTAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022023-01-01COLLEEN JONES2024-09-12
5022022-01-01COLLEEN JONES2023-10-10
5022021-01-01COLLEEN JONES2023-10-05

Plan Statistics for ADA WEST DERMATOLOGY, P.C. DENTAL PLAN

401k plan membership statisitcs for ADA WEST DERMATOLOGY, P.C. DENTAL PLAN

Measure Date Value
2023: ADA WEST DERMATOLOGY, P.C. DENTAL PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01105
Total number of active participants reported on line 7a of the Form 55002023-01-01104
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01104
Number of employers contributing to the scheme2023-01-010
2022: ADA WEST DERMATOLOGY, P.C. DENTAL PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01103
Total number of active participants reported on line 7a of the Form 55002022-01-01105
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01105
Number of employers contributing to the scheme2022-01-010
2021: ADA WEST DERMATOLOGY, P.C. DENTAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01100
Total number of active participants reported on line 7a of the Form 55002021-01-01103
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01103
Number of employers contributing to the scheme2021-01-010

Form 5500 Responses for ADA WEST DERMATOLOGY, P.C. DENTAL PLAN

2023: ADA WEST DERMATOLOGY, P.C. DENTAL PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan benefit arrangement – InsuranceYes
2022: ADA WEST DERMATOLOGY, P.C. DENTAL PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: ADA WEST DERMATOLOGY, P.C. DENTAL PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01First time form 5500 has been submittedYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 )
Policy contract number2406
Policy instance 1
Insurance contract or identification number2406
Number of Individuals Covered104
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $5,814
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 )
Policy contract number2406
Policy instance 1
Insurance contract or identification number2406
Number of Individuals Covered105
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,548
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $5,548
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF IDAHO, INC (National Association of Insurance Commissioners NAIC id number: 47791 )
Policy contract number2406
Policy instance 1
Insurance contract or identification number2406
Number of Individuals Covered103
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,681
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $5,681
Amount paid for insurance broker fees0
Insurance broker organization code?3

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