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| Plan Name | WILLINGBORO FAMILY DENTAL, PC MEDICAL PLAN |
| Plan identification number | 501 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | WILLINGBORO FAMILY DENTAL, PC |
| Employer identification number (EIN): | 204688108 |
| NAIC Classification: | 621210 |
| NAIC Description: | Offices of Dentists |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 501 | 2020-05-01 | JUSTIN BUCHHOLZ | 2021-08-24 | ||
| 501 | 2019-05-01 | GREGG CALABRO | 2020-08-18 | ||
| 501 | 2018-05-01 | GREGG CALABRO | 2019-11-18 | ||
| 501 | 2017-05-01 | GREGG CALABRO | 2019-04-08 |
| 2020: WILLINGBORO FAMILY DENTAL, PC MEDICAL PLAN 2020 form 5500 responses | ||
|---|---|---|
| 2020-05-01 | Type of plan entity | Single employer plan |
| 2020-05-01 | Plan funding arrangement – Insurance | Yes |
| 2020-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: WILLINGBORO FAMILY DENTAL, PC MEDICAL PLAN 2019 form 5500 responses | ||
| 2019-05-01 | Type of plan entity | Single employer plan |
| 2019-05-01 | Plan funding arrangement – Insurance | Yes |
| 2019-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: WILLINGBORO FAMILY DENTAL, PC MEDICAL PLAN 2018 form 5500 responses | ||
| 2018-05-01 | Type of plan entity | Single employer plan |
| 2018-05-01 | Plan funding arrangement – Insurance | Yes |
| 2018-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: WILLINGBORO FAMILY DENTAL, PC MEDICAL PLAN 2017 form 5500 responses | ||
| 2017-05-01 | Type of plan entity | Single employer plan |
| 2017-05-01 | First time form 5500 has been submitted | Yes |
| 2017-05-01 | Plan funding arrangement – Insurance | Yes |
| 2017-05-01 | Plan benefit arrangement – Insurance | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) | |
| Policy contract number | 259009 |
| Policy instance | 1 |
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 ) | |
| Policy contract number | WF5106 |
| Policy instance | 1 |
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 ) | |
| Policy contract number | WF5106 |
| Policy instance | 1 |
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 78026 ) | |
| Policy contract number | WF5106 |
| Policy instance | 1 |
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