401k Plan data: GRAHAM ENTERPRISE DENTAL plan

GRAHAM ENTERPRISE DENTAL 401k Plan overview

Plan Name	GRAHAM ENTERPRISE DENTAL
Plan identification number	502

GRAHAM ENTERPRISE DENTAL Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental

401k Sponsoring company profile

GRAHAM ENTERPRISE, INC. has sponsored the creation of one or more 401k plans.

Company Name: GRAHAM ENTERPRISE, INC.

Employer identification number (EIN): 363728266

NAIC Classification: 447100
NAIC Description: Gasoline Stations, Gas

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GRAHAM ENTERPRISE DENTAL

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-10-01
502 2020-10-01 KEVIN O'BRIEN 2022-02-16
502 2019-10-01 JOHN C. GRAHAM 2021-02-09
502 2018-10-01 JOHN GRAHAM 2020-04-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
502	2021-10-01
502	2020-10-01	KEVIN O'BRIEN	2022-02-16
502	2019-10-01	JOHN C. GRAHAM	2021-02-09
502	2018-10-01	JOHN GRAHAM	2020-04-01

Plan Statistics for GRAHAM ENTERPRISE DENTAL

401k plan membership statisitcs for GRAHAM ENTERPRISE DENTAL

Measure Date Value
2021: GRAHAM ENTERPRISE DENTAL 2021 401k membership
Total participants, beginning-of-year 2021-10-01 120
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 187
Total of all active and inactive participants 2021-10-01 187
Total participants 2021-10-01 187
2020: GRAHAM ENTERPRISE DENTAL 2020 401k membership
Total participants, beginning-of-year 2020-10-01 148
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 120
Number of retired or separated participants receiving benefits 2020-10-01 0
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 120
Number of employers contributing to the scheme 2020-10-01 0
2019: GRAHAM ENTERPRISE DENTAL 2019 401k membership
Total participants, beginning-of-year 2019-10-01 153
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 148
Number of retired or separated participants receiving benefits 2019-10-01 0
Number of other retired or separated participants entitled to future benefits 2019-10-01 0
Total of all active and inactive participants 2019-10-01 148
Number of employers contributing to the scheme 2019-10-01 0
2018: GRAHAM ENTERPRISE DENTAL 2018 401k membership
Total participants, beginning-of-year 2018-10-01 172
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 147
Number of retired or separated participants receiving benefits 2018-10-01 0
Number of other retired or separated participants entitled to future benefits 2018-10-01 0
Total of all active and inactive participants 2018-10-01 147
Number of employers contributing to the scheme 2018-10-01 0

Measure	Date	Value
2021: GRAHAM ENTERPRISE DENTAL 2021 401k membership
Total participants, beginning-of-year	2021-10-01	120
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	187
Total of all active and inactive participants	2021-10-01	187
Total participants	2021-10-01	187
2020: GRAHAM ENTERPRISE DENTAL 2020 401k membership
Total participants, beginning-of-year	2020-10-01	148
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	120
Number of retired or separated participants receiving benefits	2020-10-01	0
Number of other retired or separated participants entitled to future benefits	2020-10-01	0
Total of all active and inactive participants	2020-10-01	120
Number of employers contributing to the scheme	2020-10-01	0
2019: GRAHAM ENTERPRISE DENTAL 2019 401k membership
Total participants, beginning-of-year	2019-10-01	153
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	148
Number of retired or separated participants receiving benefits	2019-10-01	0
Number of other retired or separated participants entitled to future benefits	2019-10-01	0
Total of all active and inactive participants	2019-10-01	148
Number of employers contributing to the scheme	2019-10-01	0
2018: GRAHAM ENTERPRISE DENTAL 2018 401k membership
Total participants, beginning-of-year	2018-10-01	172
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	147
Number of retired or separated participants receiving benefits	2018-10-01	0
Number of other retired or separated participants entitled to future benefits	2018-10-01	0
Total of all active and inactive participants	2018-10-01	147
Number of employers contributing to the scheme	2018-10-01	0

Form 5500 Responses for GRAHAM ENTERPRISE DENTAL

2021: GRAHAM ENTERPRISE DENTAL 2021 form 5500 responses
2021-10-01	Type of plan entity	Single employer plan
2021-10-01	Submission has been amended	No
2021-10-01	This submission is the final filing	No
2021-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-10-01	Plan is a collectively bargained plan	No
2021-10-01	Plan funding arrangement – Insurance	Yes
2021-10-01	Plan benefit arrangement – Insurance	Yes
2020: GRAHAM ENTERPRISE DENTAL 2020 form 5500 responses
2020-10-01	Type of plan entity	Single employer plan
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2019: GRAHAM ENTERPRISE DENTAL 2019 form 5500 responses
2019-10-01	Type of plan entity	Single employer plan
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – Insurance	Yes
2018: GRAHAM ENTERPRISE DENTAL 2018 form 5500 responses
2018-10-01	Type of plan entity	Single employer plan
2018-10-01	First time form 5500 has been submitted	Yes
2018-10-01	Plan funding arrangement – Insurance	Yes
2018-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

3344583

Policy instance

Insurance contract or identification number	3344583
Number of Individuals Covered	125
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $1,026
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	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 $61,993
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $863
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

678148

Policy instance

Insurance contract or identification number	678148
Number of Individuals Covered	120
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $2,919
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,919
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )

Policy contract number

678148

Policy instance

Insurance contract or identification number	678148
Number of Individuals Covered	143
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $3,026
Total amount of fees paid to insurance company	USD $2,163
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,545
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,026
Amount paid for insurance broker fees	2163
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

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

Policy contract number

210540

Policy instance

Insurance contract or identification number	210540
Number of Individuals Covered	207
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $5,165
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $77,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $5,165
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

Potentially related plans

GRAHAM ENTERPRISES INC. WELFARE PLAN [EIN = 470558386]

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Company Name:	GRAHAM ENTERPRISE, INC.
Employer identification number (EIN):	363728266
NAIC Classification:	447100
NAIC Description:	Gasoline Stations, Gas