401k Plan data: DELTA DENTAL PLAN OF OKLAHOMA, INC plan

DELTA DENTAL PLAN OF OKLAHOMA, INC 401k Plan overview

Plan Name	DELTA DENTAL PLAN OF OKLAHOMA, INC
Plan identification number	001

DELTA DENTAL PLAN OF OKLAHOMA, INC Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
U.S.-based plan that covers residents of Puerto Rico and is qualified under both Code section 401 and section 1165 of the Puerto Rico Code.

401k Sponsoring company profile

DELTA DENTAL PLAN OF OKLAHOMA, INC. has sponsored the creation of one or more 401k plans.

Company Name: DELTA DENTAL PLAN OF OKLAHOMA, INC.

Employer identification number (EIN): 237322578

NAIC Classification: 524150

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DELTA DENTAL PLAN OF OKLAHOMA, INC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 ASHLEY ALBRIGHT 2023-10-02
001 2021-01-01 ASHLEY ALBRIGHT 2022-08-07
001 2020-01-01 ASHLEY ALBRIGHT 2021-08-04
001 2019-01-01 ASHLEY ALBRIGHT 2020-07-28
001 2018-01-01 FRANK TURBEVILLE 2019-07-23
001 2017-01-01
001 2016-01-01 ASHLEY ALBRIGHT 2017-06-21
001 2015-01-01 FRANK TURBEVILLE FRANK TURBEVILLE 2016-07-14
001 2015-01-01 ASHLEY ALBRIGHT 2016-07-20
001 2014-01-01 STEPHANIE ELLIOTT STEPHANIE ELLIOTT 2015-07-31
001 2014-01-01 STEPHANIE ELLIOTT 2015-10-12
001 2013-01-01 STEPHANIE ELLIOTT 2014-10-13
001 2012-01-01 STEPHANIE WADE
001 2011-01-01 STEPHANIE WADE
001 2009-01-01 STEPHANIE ELLIOTT

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	ASHLEY ALBRIGHT	2023-10-02
001	2021-01-01	ASHLEY ALBRIGHT	2022-08-07
001	2020-01-01	ASHLEY ALBRIGHT	2021-08-04
001	2019-01-01	ASHLEY ALBRIGHT	2020-07-28
001	2018-01-01	FRANK TURBEVILLE	2019-07-23
001	2017-01-01
001	2016-01-01	ASHLEY ALBRIGHT	2017-06-21
001	2015-01-01	FRANK TURBEVILLE		FRANK TURBEVILLE	2016-07-14
001	2015-01-01	ASHLEY ALBRIGHT	2016-07-20
001	2014-01-01	STEPHANIE ELLIOTT		STEPHANIE ELLIOTT	2015-07-31
001	2014-01-01	STEPHANIE ELLIOTT	2015-10-12
001	2013-01-01	STEPHANIE ELLIOTT	2014-10-13
001	2012-01-01	STEPHANIE WADE
001	2011-01-01	STEPHANIE WADE
001	2009-01-01	STEPHANIE ELLIOTT

Plan Statistics for DELTA DENTAL PLAN OF OKLAHOMA, INC

401k plan membership statisitcs for DELTA DENTAL PLAN OF OKLAHOMA, INC

Measure Date Value
2022: DELTA DENTAL PLAN OF OKLAHOMA, INC 2022 401k membership
Total participants, beginning-of-year 2022-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 120
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 17
Total of all active and inactive participants 2022-01-01 137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 2
Total participants 2022-01-01 139
Number of participants with account balances 2022-01-01 139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 2
2021: DELTA DENTAL PLAN OF OKLAHOMA, INC 2021 401k membership
Total participants, beginning-of-year 2021-01-01 139
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 116
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 20
Total of all active and inactive participants 2021-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 2
Total participants 2021-01-01 138
Number of participants with account balances 2021-01-01 138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 8
2020: DELTA DENTAL PLAN OF OKLAHOMA, INC 2020 401k membership
Total participants, beginning-of-year 2020-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 121
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 17
Total of all active and inactive participants 2020-01-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 1
Total participants 2020-01-01 139
Number of participants with account balances 2020-01-01 139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 3
2019: DELTA DENTAL PLAN OF OKLAHOMA, INC 2019 401k membership
Total participants, beginning-of-year 2019-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 123
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 20
Total of all active and inactive participants 2019-01-01 143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 1
Total participants 2019-01-01 144
Number of participants with account balances 2019-01-01 142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 4
2018: DELTA DENTAL PLAN OF OKLAHOMA, INC 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 2018-01-01 120
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 14
Total of all active and inactive participants 2018-01-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 1
Total participants 2018-01-01 135
Number of participants with account balances 2018-01-01 133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 6
2017: DELTA DENTAL PLAN OF OKLAHOMA, INC 2017 401k membership
Total participants, beginning-of-year 2017-01-01 143
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 123
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 13
Total of all active and inactive participants 2017-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 1
Total participants 2017-01-01 137
Number of participants with account balances 2017-01-01 135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 5
2015: DELTA DENTAL PLAN OF OKLAHOMA, INC 2015 401k membership
Total participants, beginning-of-year 2015-01-01 93
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 112
Total of all active and inactive participants 2015-01-01 112
Total participants 2015-01-01 112
2014: DELTA DENTAL PLAN OF OKLAHOMA, INC 2014 401k membership
Total participants, beginning-of-year 2014-01-01 89
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 93
Total of all active and inactive participants 2014-01-01 93
Total participants 2014-01-01 93
2012: DELTA DENTAL PLAN OF OKLAHOMA, INC 2012 401k membership
Total participants, beginning-of-year 2012-01-01 87
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 80
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 3
Total of all active and inactive participants 2012-01-01 83
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 83
Number of participants with account balances 2012-01-01 83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: DELTA DENTAL PLAN OF OKLAHOMA, INC 2011 401k membership
Total participants, beginning-of-year 2011-01-01 91
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 82
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 3
Total of all active and inactive participants 2011-01-01 85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 2
Total participants 2011-01-01 87
Number of participants with account balances 2011-01-01 87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 2
2009: DELTA DENTAL PLAN OF OKLAHOMA, INC 2009 401k membership
Total participants, beginning-of-year 2009-01-01 74
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 75
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 3
Total of all active and inactive participants 2009-01-01 78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 78
Number of participants with account balances 2009-01-01 77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2022: DELTA DENTAL PLAN OF OKLAHOMA, INC 2022 401k membership
Total participants, beginning-of-year	2022-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	120
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	17
Total of all active and inactive participants	2022-01-01	137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	2
Total participants	2022-01-01	139
Number of participants with account balances	2022-01-01	139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	2
2021: DELTA DENTAL PLAN OF OKLAHOMA, INC 2021 401k membership
Total participants, beginning-of-year	2021-01-01	139
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	116
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	20
Total of all active and inactive participants	2021-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	2
Total participants	2021-01-01	138
Number of participants with account balances	2021-01-01	138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	8
2020: DELTA DENTAL PLAN OF OKLAHOMA, INC 2020 401k membership
Total participants, beginning-of-year	2020-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	121
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	17
Total of all active and inactive participants	2020-01-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	1
Total participants	2020-01-01	139
Number of participants with account balances	2020-01-01	139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	3
2019: DELTA DENTAL PLAN OF OKLAHOMA, INC 2019 401k membership
Total participants, beginning-of-year	2019-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	123
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	20
Total of all active and inactive participants	2019-01-01	143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	144
Number of participants with account balances	2019-01-01	142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	4
2018: DELTA DENTAL PLAN OF OKLAHOMA, INC 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	120
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	14
Total of all active and inactive participants	2018-01-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	135
Number of participants with account balances	2018-01-01	133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	6
2017: DELTA DENTAL PLAN OF OKLAHOMA, INC 2017 401k membership
Total participants, beginning-of-year	2017-01-01	143
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	123
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	13
Total of all active and inactive participants	2017-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	1
Total participants	2017-01-01	137
Number of participants with account balances	2017-01-01	135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	5
2015: DELTA DENTAL PLAN OF OKLAHOMA, INC 2015 401k membership
Total participants, beginning-of-year	2015-01-01	93
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	112
Total of all active and inactive participants	2015-01-01	112
Total participants	2015-01-01	112
2014: DELTA DENTAL PLAN OF OKLAHOMA, INC 2014 401k membership
Total participants, beginning-of-year	2014-01-01	89
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	93
Total of all active and inactive participants	2014-01-01	93
Total participants	2014-01-01	93
2012: DELTA DENTAL PLAN OF OKLAHOMA, INC 2012 401k membership
Total participants, beginning-of-year	2012-01-01	87
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	80
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	3
Total of all active and inactive participants	2012-01-01	83
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	83
Number of participants with account balances	2012-01-01	83
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: DELTA DENTAL PLAN OF OKLAHOMA, INC 2011 401k membership
Total participants, beginning-of-year	2011-01-01	91
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	82
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	3
Total of all active and inactive participants	2011-01-01	85
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	2
Total participants	2011-01-01	87
Number of participants with account balances	2011-01-01	87
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	2
2009: DELTA DENTAL PLAN OF OKLAHOMA, INC 2009 401k membership
Total participants, beginning-of-year	2009-01-01	74
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	75
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	78
Number of participants with account balances	2009-01-01	77
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on DELTA DENTAL PLAN OF OKLAHOMA, INC

Measure	Date	Value
2022 : DELTA DENTAL PLAN OF OKLAHOMA, INC 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$-1,441,530
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$1,052,698
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,046,515
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,757,020
Value of total assets at end of year	2022-12-31	$17,609,716
Value of total assets at beginning of year	2022-12-31	$20,103,944
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$6,183
Total interest from all sources	2022-12-31	$43,418
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$900,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$705,342
Participant contributions at end of year	2022-12-31	$318,489
Participant contributions at beginning of year	2022-12-31	$253,619
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-2,494,228
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$17,609,716
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$20,103,944
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in pooled separate accounts at end of year	2022-12-31	$14,534,052
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$17,093,708
Interest on participant loans	2022-12-31	$9,791
Interest earned on other investments	2022-12-31	$33,627
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$1,905,024
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$1,938,605
Net investment gain/loss from pooled separate accounts	2022-12-31	$-3,241,968
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$1,051,678
Employer contributions (assets) at end of year	2022-12-31	$852,151
Employer contributions (assets) at beginning of year	2022-12-31	$818,012
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$1,046,515
Contract administrator fees	2022-12-31	$6,183
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	RSM US, LLP
Accountancy firm EIN	2022-12-31	420714325
2021 : DELTA DENTAL PLAN OF OKLAHOMA, INC 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$3,967,552
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$423,718
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$419,043
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$1,675,649
Value of total assets at end of year	2021-12-31	$20,103,944
Value of total assets at beginning of year	2021-12-31	$16,560,110
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$4,675
Total interest from all sources	2021-12-31	$39,211
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$663,504
Participant contributions at end of year	2021-12-31	$253,619
Participant contributions at beginning of year	2021-12-31	$256,337
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$3,543,834
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$20,103,944
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$16,560,110
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in pooled separate accounts at end of year	2021-12-31	$17,093,708
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$13,835,385
Interest on participant loans	2021-12-31	$11,082
Interest earned on other investments	2021-12-31	$28,129
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$1,938,605
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$1,655,592
Net investment gain/loss from pooled separate accounts	2021-12-31	$2,252,692
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$1,012,145
Employer contributions (assets) at end of year	2021-12-31	$818,012
Employer contributions (assets) at beginning of year	2021-12-31	$812,796
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$419,043
Contract administrator fees	2021-12-31	$4,675
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	RSM US, LLP
Accountancy firm EIN	2021-12-31	420714325
2020 : DELTA DENTAL PLAN OF OKLAHOMA, INC 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$3,647,702
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$447,581
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$444,404
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,601,624
Value of total assets at end of year	2020-12-31	$16,560,110
Value of total assets at beginning of year	2020-12-31	$13,359,989
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$3,177
Total interest from all sources	2020-12-31	$36,390
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$571,597
Participant contributions at end of year	2020-12-31	$256,337
Participant contributions at beginning of year	2020-12-31	$267,856
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$24,062
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$3,200,121
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$16,560,110
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$13,359,989
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in pooled separate accounts at end of year	2020-12-31	$13,835,385
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$11,105,363
Interest on participant loans	2020-12-31	$12,245
Interest earned on other investments	2020-12-31	$24,145
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$1,655,592
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$1,286,788
Net investment gain/loss from pooled separate accounts	2020-12-31	$2,009,688
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$1,005,965
Employer contributions (assets) at end of year	2020-12-31	$812,796
Employer contributions (assets) at beginning of year	2020-12-31	$699,982
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$444,404
Contract administrator fees	2020-12-31	$3,177
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	RSM US, LLP
Accountancy firm EIN	2020-12-31	420714325
2019 : DELTA DENTAL PLAN OF OKLAHOMA, INC 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$3,474,311
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$169,737
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$164,714
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,366,090
Value of total assets at end of year	2019-12-31	$13,359,989
Value of total assets at beginning of year	2019-12-31	$10,055,415
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$5,023
Total interest from all sources	2019-12-31	$30,105
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$800,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$485,760
Participant contributions at end of year	2019-12-31	$267,856
Participant contributions at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$48,624
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$3,304,574
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$13,359,989
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$10,055,415
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in pooled separate accounts at end of year	2019-12-31	$11,105,363
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$8,175,992
Interest on participant loans	2019-12-31	$8,546
Interest earned on other investments	2019-12-31	$21,559
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,286,788
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$1,172,101
Net investment gain/loss from pooled separate accounts	2019-12-31	$2,078,116
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$831,706
Employer contributions (assets) at end of year	2019-12-31	$699,982
Employer contributions (assets) at beginning of year	2019-12-31	$707,322
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$164,714
Contract administrator fees	2019-12-31	$5,023
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	RSM US LLP
Accountancy firm EIN	2019-12-31	463404304
2018 : DELTA DENTAL PLAN OF OKLAHOMA, INC 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$880,768
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,566,763
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,565,170
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,348,993
Value of total assets at end of year	2018-12-31	$10,055,415
Value of total assets at beginning of year	2018-12-31	$10,741,410
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$1,593
Total interest from all sources	2018-12-31	$23,913
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$800,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$444,554
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$27,889
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-685,995
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$10,055,415
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$10,741,410
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in pooled separate accounts at end of year	2018-12-31	$8,175,992
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$8,866,406
Interest earned on other investments	2018-12-31	$23,913
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$1,172,101
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$1,317,556
Net investment gain/loss from pooled separate accounts	2018-12-31	$-492,138
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$876,550
Employer contributions (assets) at end of year	2018-12-31	$707,322
Employer contributions (assets) at beginning of year	2018-12-31	$557,448
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,565,170
Contract administrator fees	2018-12-31	$1,593
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	RSM US, LLP
Accountancy firm EIN	2018-12-31	463404304
2017 : DELTA DENTAL PLAN OF OKLAHOMA, INC 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$2,966,225
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$477,891
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$475,917
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,631,220
Value of total assets at end of year	2017-12-31	$10,741,410
Value of total assets at beginning of year	2017-12-31	$8,253,076
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$1,974
Total interest from all sources	2017-12-31	$19,966
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$50,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$405,078
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$20,266
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$2,488,334
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$10,741,410
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$8,253,076
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in pooled separate accounts at end of year	2017-12-31	$8,866,406
Value of interest in pooled separate accounts at beginning of year	2017-12-31	$7,030,323
Interest earned on other investments	2017-12-31	$19,966
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$1,317,556
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,222,753
Net investment gain/loss from pooled separate accounts	2017-12-31	$1,315,039
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$1,205,876
Employer contributions (assets) at end of year	2017-12-31	$557,448
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$475,917
Contract administrator fees	2017-12-31	$1,974
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	RSM US, LLP
Accountancy firm EIN	2017-12-31	463404304
2012 : DELTA DENTAL PLAN OF OKLAHOMA, INC 2012 401k financial data
Total income from all sources	2012-12-31	$1,252,063
Expenses. Total of all expenses incurred	2012-12-31	$158,759
Benefits paid (including direct rollovers)	2012-12-31	$155,043
Total plan assets at end of year	2012-12-31	$5,192,644
Total plan assets at beginning of year	2012-12-31	$4,099,340
Value of fidelity bond covering the plan	2012-12-31	$50,000
Total contributions received or receivable from participants	2012-12-31	$224,722
Other income received	2012-12-31	$579,279
Net income (gross income less expenses)	2012-12-31	$1,093,304
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$5,192,644
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$4,099,340
Total contributions received or receivable from employer(s)	2012-12-31	$448,062
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$3,716
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : DELTA DENTAL PLAN OF OKLAHOMA, INC 2011 401k financial data
Total income from all sources	2011-12-31	$874,271
Expenses. Total of all expenses incurred	2011-12-31	$272,649
Benefits paid (including direct rollovers)	2011-12-31	$265,592
Total plan assets at end of year	2011-12-31	$4,099,340
Total plan assets at beginning of year	2011-12-31	$3,497,718
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$205,830
Other income received	2011-12-31	$-92,471
Net income (gross income less expenses)	2011-12-31	$601,622
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$4,099,340
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$3,497,718
Total contributions received or receivable from employer(s)	2011-12-31	$760,912
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$7,057
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : DELTA DENTAL PLAN OF OKLAHOMA, INC 2010 401k financial data
Total income from all sources	2010-12-31	$729,184
Expenses. Total of all expenses incurred	2010-12-31	$47,093
Benefits paid (including direct rollovers)	2010-12-31	$41,035
Total plan assets at end of year	2010-12-31	$3,497,718
Total plan assets at beginning of year	2010-12-31	$2,815,627
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$182,690
Expenses. Other expenses not covered elsewhere	2010-12-31	$31
Other income received	2010-12-31	$433,173
Net income (gross income less expenses)	2010-12-31	$682,091
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$3,497,718
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,815,627
Total contributions received or receivable from employer(s)	2010-12-31	$113,321
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$6,027
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : DELTA DENTAL PLAN OF OKLAHOMA, INC 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for DELTA DENTAL PLAN OF OKLAHOMA, INC

2022: DELTA DENTAL PLAN OF OKLAHOMA, INC 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: DELTA DENTAL PLAN OF OKLAHOMA, INC 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: DELTA DENTAL PLAN OF OKLAHOMA, INC 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: DELTA DENTAL PLAN OF OKLAHOMA, INC 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: DELTA DENTAL PLAN OF OKLAHOMA, INC 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: DELTA DENTAL PLAN OF OKLAHOMA, INC 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2015: DELTA DENTAL PLAN OF OKLAHOMA, INC 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
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: DELTA DENTAL PLAN OF OKLAHOMA, INC 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
2012: DELTA DENTAL PLAN OF OKLAHOMA, INC 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: DELTA DENTAL PLAN OF OKLAHOMA, INC 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: DELTA DENTAL PLAN OF OKLAHOMA, INC 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

809568

Policy instance

Insurance contract or identification number	809568
Number of Individuals Covered	139
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $34,522
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,522
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

809568

Policy instance

Insurance contract or identification number	809568
Number of Individuals Covered	138
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $35,630
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,630
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

809568

Policy instance

Insurance contract or identification number	809568
Number of Individuals Covered	139
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $33,044
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $33,044
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

809568

Policy instance

Insurance contract or identification number	809568
Number of Individuals Covered	144
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $27,972
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,972
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

809568

Policy instance

Insurance contract or identification number	809568
Number of Individuals Covered	135
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $27,881
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $27,881
Insurance broker organization code?	3

STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )

Policy contract number

809568

Policy instance

Insurance contract or identification number	809568
Number of Individuals Covered	137
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $28,285
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,753
Insurance broker organization code?	3
Insurance broker name	BIRCHALL AND HAMPTON LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 95478 )

Policy contract number

01115000

Policy instance

Insurance contract or identification number	01115000
Number of Individuals Covered	99
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
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	No
Vision Insurance Welfare Benefit	Yes
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 $16,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

123766

Policy instance

Insurance contract or identification number	123766
Number of Individuals Covered	180
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $2,360
Total amount of fees paid to insurance company	USD $530
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
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 $16,198
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

123766

Policy instance

Insurance contract or identification number	123766
Number of Individuals Covered	180
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $1,608
Total amount of fees paid to insurance company	USD $659
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	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
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 $17,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 53937 )

Policy contract number

1100

Policy instance

Insurance contract or identification number	1100
Number of Individuals Covered	99
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $0
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

BLUECROSS BLUESHIELD OF TEXAS (National Association of Insurance Commissioners NAIC id number: 70670 )

Policy contract number

YOE126

Policy instance

Insurance contract or identification number	YOE126
Number of Individuals Covered	164
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $48,727
Total amount of fees paid to insurance company	USD $820
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	Yes
Dental 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
Welfare Benefit Premiums Paid to Carrier	USD $1,010,735
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	DELTA DENTAL PLAN OF OKLAHOMA, INC.
Employer identification number (EIN):	237322578
NAIC Classification:	524150