401k Plan data: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN plan

COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 401k Plan overview

Plan Name	COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN
Plan identification number	503

COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Dental Vision

401k Sponsoring company profile

COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP has sponsored the creation of one or more 401k plans.

Company Name: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP

Employer identification number (EIN): 472484675

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2021-10-01
503 2020-10-01
503 2019-10-01
503 2019-10-01
503 2018-10-01

Plan Statistics for COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN

401k plan membership statisitcs for COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN

Measure Date Value
2021: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2021 401k membership
Total participants, beginning-of-year 2021-10-01 151
Total number of active participants reported on line 7a of the Form 5500 2021-10-01 145
Number of retired or separated participants receiving benefits 2021-10-01 1
Number of other retired or separated participants entitled to future benefits 2021-10-01 0
Total of all active and inactive participants 2021-10-01 146
2020: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2020 401k membership
Total participants, beginning-of-year 2020-10-01 170
Total number of active participants reported on line 7a of the Form 5500 2020-10-01 161
Number of retired or separated participants receiving benefits 2020-10-01 6
Number of other retired or separated participants entitled to future benefits 2020-10-01 0
Total of all active and inactive participants 2020-10-01 167
2019: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2019 401k membership
Total participants, beginning-of-year 2019-10-01 140
Total number of active participants reported on line 7a of the Form 5500 2019-10-01 156
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 2019-10-01 156
2018: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2018 401k membership
Total participants, beginning-of-year 2018-10-01 122
Total number of active participants reported on line 7a of the Form 5500 2018-10-01 140
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 2018-10-01 140

Measure	Date	Value
2021: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2021 401k membership
Total participants, beginning-of-year	2021-10-01	151
Total number of active participants reported on line 7a of the Form 5500	2021-10-01	145
Number of retired or separated participants receiving benefits	2021-10-01	1
Number of other retired or separated participants entitled to future benefits	2021-10-01	0
Total of all active and inactive participants	2021-10-01	146
2020: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2020 401k membership
Total participants, beginning-of-year	2020-10-01	170
Total number of active participants reported on line 7a of the Form 5500	2020-10-01	161
Number of retired or separated participants receiving benefits	2020-10-01	6
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	167
2019: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2019 401k membership
Total participants, beginning-of-year	2019-10-01	140
Total number of active participants reported on line 7a of the Form 5500	2019-10-01	156
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	156
2018: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2018 401k membership
Total participants, beginning-of-year	2018-10-01	122
Total number of active participants reported on line 7a of the Form 5500	2018-10-01	140
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	140

Form 5500 Responses for COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN

2021: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2021 form 5500 responses
2021-10-01	Type of plan entity	Mulitple 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: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2020 form 5500 responses
2020-10-01	Type of plan entity	Mulitple employer plan
2020-10-01	Submission has been amended	No
2020-10-01	This submission is the final filing	No
2020-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-10-01	Plan is a collectively bargained plan	No
2020-10-01	Plan funding arrangement – Insurance	Yes
2020-10-01	Plan benefit arrangement – Insurance	Yes
2019: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2019 form 5500 responses
2019-10-01	Type of plan entity	Mulitple employer plan
2019-10-01	Submission has been amended	Yes
2019-10-01	This submission is the final filing	No
2019-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-10-01	Plan is a collectively bargained plan	No
2019-10-01	Plan funding arrangement – Insurance	Yes
2019-10-01	Plan benefit arrangement – Insurance	Yes
2018: COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP DENTAL AND VISION PLAN 2018 form 5500 responses
2018-10-01	Type of plan entity	Mulitple employer plan
2018-10-01	First time form 5500 has been submitted	Yes
2018-10-01	Submission has been amended	No
2018-10-01	This submission is the final filing	No
2018-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-10-01	Plan is a collectively bargained plan	No
2018-10-01	Plan funding arrangement – Insurance	Yes
2018-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GACAAPASSN

Policy instance

Insurance contract or identification number	GACAAPASSN
Number of Individuals Covered	275
Insurance policy start date	2021-10-01
Insurance policy end date	2022-09-30
Total amount of commissions paid to insurance broker	USD $156,152
Total amount of fees paid to insurance company	USD $945
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	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 $125,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $141,398
Amount paid for insurance broker fees	945
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA6429

Policy instance

Insurance contract or identification number	GA6429
Number of Individuals Covered	310
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Total amount of commissions paid to insurance broker	USD $168,689
Total amount of fees paid to insurance company	USD $8,931
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	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 $160,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $151,322
Amount paid for insurance broker fees	8931
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF GEORGIA INC. (G0386) (National Association of Insurance Commissioners NAIC id number: 96962 )

Policy contract number

GA6429

Policy instance

Insurance contract or identification number	GA6429
Number of Individuals Covered	264
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Total amount of commissions paid to insurance broker	USD $227,452
Total amount of fees paid to insurance company	USD $136
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	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 $112,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $211,952
Amount paid for insurance broker fees	136
Additional information about fees paid to insurance broker	FEES PAID
Insurance broker organization code?	3

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

Policy contract number

136-006741

Policy instance

Insurance contract or identification number	136-006741
Number of Individuals Covered	305
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Total amount of commissions paid to insurance broker	USD $7,990
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	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 $99,877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,990
Insurance broker organization code?	3

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Company Name:	COMMUNITY ALIGNED ASSOCIATION OF PHYSICIANS, INC. DBA CAAP
Employer identification number (EIN):	472484675
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations