401k Plan data: GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC plan

GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC 401k Plan overview

Plan Name	GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC
Plan identification number	502

GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

PM PEDIATRICS MANAGEMENT GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: PM PEDIATRICS MANAGEMENT GROUP, LLC

Employer identification number (EIN): 331067457

NAIC Classification: 561110
NAIC Description: Office Administrative Services

Additional information about PM PEDIATRICS MANAGEMENT GROUP, LLC

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 2003-03-28

Company Identification Number: 2887993

Legal Registered Office Address: ONE HOLLOW LANE, SUITE 301
Nassau
LAKE SUCCESS
United States of America (USA)
11042

More information about PM PEDIATRICS MANAGEMENT GROUP, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2015-04-01 RACHEL FRIEDMAN
502 2014-04-01 RACHEL FRIEDMAN RACHEL FRIEDMAN 2015-10-09

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2015-04-01	RACHEL FRIEDMAN
502	2014-04-01	RACHEL FRIEDMAN		RACHEL FRIEDMAN	2015-10-09

Plan Statistics for GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC

401k plan membership statisitcs for GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC

Measure Date Value
2015: GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC 2015 401k membership
Total participants, beginning-of-year 2015-04-01 241
Total number of active participants reported on line 7a of the Form 5500 2015-04-01 0
Number of retired or separated participants receiving benefits 2015-04-01 0
Number of other retired or separated participants entitled to future benefits 2015-04-01 0
Total of all active and inactive participants 2015-04-01 0
2014: GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC 2014 401k membership
Total participants, beginning-of-year 2014-04-01 95
Total number of active participants reported on line 7a of the Form 5500 2014-04-01 95
Total of all active and inactive participants 2014-04-01 95

Measure	Date	Value
2015: GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC 2015 401k membership
Total participants, beginning-of-year	2015-04-01	241
Total number of active participants reported on line 7a of the Form 5500	2015-04-01	0
Number of retired or separated participants receiving benefits	2015-04-01	0
Number of other retired or separated participants entitled to future benefits	2015-04-01	0
Total of all active and inactive participants	2015-04-01	0
2014: GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC 2014 401k membership
Total participants, beginning-of-year	2014-04-01	95
Total number of active participants reported on line 7a of the Form 5500	2014-04-01	95
Total of all active and inactive participants	2014-04-01	95

Form 5500 Responses for GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC

2015: GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC 2015 form 5500 responses
2015-04-01	Type of plan entity	Single employer plan
2015-04-01	Submission has been amended	No
2015-04-01	This submission is the final filing	Yes
2015-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-04-01	Plan is a collectively bargained plan	No
2015-04-01	Plan funding arrangement – Insurance	Yes
2015-04-01	Plan benefit arrangement – Insurance	Yes
2014: GROUP VOLUNTARY DENTAL INSURANCE FOR THE EMPLOYEES OF PM PEDIATRICS MANAGEMENT GROUP, LLC 2014 form 5500 responses
2014-04-01	Type of plan entity	Single employer plan
2014-04-01	First time form 5500 has been submitted	Yes
2014-04-01	Submission has been amended	No
2014-04-01	This submission is the final filing	No
2014-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-04-01	Plan is a collectively bargained plan	No
2014-04-01	Plan funding arrangement – Insurance	Yes
2014-04-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNION SECURITY DENTALCARE OF NEW JERSEY, INC. (National Association of Insurance Commissioners NAIC id number: 11244 )

Policy contract number

5467485

Policy instance

Insurance contract or identification number	5467485
Number of Individuals Covered	11
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $2,629
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK 4D DENTAL (National Association of Insurance Commissioners NAIC id number: 81477 )

Policy contract number

5462853

Policy instance

Insurance contract or identification number	5462853
Number of Individuals Covered	50
Insurance policy start date	2015-04-01
Insurance policy end date	2016-03-31
Total amount of commissions paid to insurance broker	USD $7,421
Total amount of fees paid to insurance company	USD $1,282
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $74,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,857
Insurance broker organization code?	3
Amount paid for insurance broker fees	1282
Additional information about fees paid to insurance broker	FEES
Insurance broker name	PROFESSIONAL GROUP PLANS INC

UNION SECURITY DENTALCARE OF NEW JERSEY, INC. (National Association of Insurance Commissioners NAIC id number: 11244 )

Policy contract number

5467485

Policy instance

Insurance contract or identification number	5467485
Number of Individuals Covered	9
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	LADMAR ASSOCIATES LLC

UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK 4D DENTAL (National Association of Insurance Commissioners NAIC id number: 81477 )

Policy contract number

5462853

Policy instance

Insurance contract or identification number	5462853
Number of Individuals Covered	86
Insurance policy start date	2014-04-01
Insurance policy end date	2015-03-31
Total amount of commissions paid to insurance broker	USD $6,468
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,468
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	LADMAR ASSOCIATES LLC

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Company Name:	PM PEDIATRICS MANAGEMENT GROUP, LLC
Employer identification number (EIN):	331067457
NAIC Classification:	561110
NAIC Description:	Office Administrative Services

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	2003-03-28
Company Identification Number:	2887993
Legal Registered Office Address:	ONE HOLLOW LANE, SUITE 301 Nassau LAKE SUCCESS United States of America (USA) 11042