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| Plan Name | BAYVIEW DENTAL ASSOCIATES EMPLOYEE WELFARE BENEFITS PLAN |
| Plan identification number | 510 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | BAYVIEW DENTAL HEALTH PROFESSIONALS, P.A. |
| Employer identification number (EIN): | 452546142 |
| NAIC Classification: | 621210 |
| NAIC Description: | Offices of Dentists |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 510 | 2022-06-01 | ||||
| 510 | 2022-06-01 | ASHLEY SHAW-LESTER |
| 2022: BAYVIEW DENTAL ASSOCIATES EMPLOYEE WELFARE BENEFITS PLAN 2022 form 5500 responses | ||
|---|---|---|
| 2022-06-01 | Type of plan entity | Single employer plan |
| 2022-06-01 | First time form 5500 has been submitted | Yes |
| 2022-06-01 | Submission has been amended | No |
| 2022-06-01 | This submission is the final filing | No |
| 2022-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-06-01 | Plan is a collectively bargained plan | No |
| 2022-06-01 | Plan funding arrangement – Insurance | Yes |
| 2022-06-01 | Plan benefit arrangement – Insurance | Yes |
| AMERICAN PUBLIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60801 ) | |
| Policy contract number | 23350 |
| Policy instance | 1 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 98167 ) | |
| Policy contract number | B1810 |
| Policy instance | 2 |
| BLUE CROSS BLUE SHIELD OF FLORIDA (National Association of Insurance Commissioners NAIC id number: 95089 ) | |
| Policy contract number | B1810 |
| Policy instance | 3 |
| HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 ) | |
| Policy contract number | 847003 |
| Policy instance | 4 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) | |
| Policy contract number | 50048125 |
| Policy instance | 5 |
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) | |
| Policy contract number | 1158395 |
| Policy instance | 6 |
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