401k Plan data: NASHVILLE DENTAL, INC. 401K PLAN plan

NASHVILLE DENTAL, INC. 401K PLAN 401k Plan overview

Plan Name	NASHVILLE DENTAL, INC. 401K PLAN
Plan identification number	002

NASHVILLE DENTAL, INC. 401K PLAN 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.
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.

401k Sponsoring company profile

NASHVILLE DENTAL, INC. has sponsored the creation of one or more 401k plans.

Company Name: NASHVILLE DENTAL, INC.

Employer identification number (EIN): 620304640

NAIC Classification: 621510
NAIC Description: Medical and Diagnostic Laboratories

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NASHVILLE DENTAL, INC. 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2023-01-01
002 2022-01-01
002 2021-01-01
002 2020-01-01 KARL HAMM 2021-03-22
002 2019-01-01 KARL HAMM 2020-05-06
002 2018-01-01 KARL HAMM 2019-04-18
002 2017-01-01 KARL HAMM 2018-05-04
002 2016-01-01 KARL HAMM 2017-04-06
002 2015-01-01 KARL HAMM 2016-05-26
002 2014-01-01 SUSAN BROCK 2015-07-22
002 2013-01-01 SUSAN BROCK 2014-07-24
002 2012-01-01 SUSAN BROCK 2013-07-16
002 2011-01-01 SUSAN BROCK 2012-06-12
002 2010-01-01 SUSAN BROCK 2011-06-17

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2023-01-01
002	2022-01-01
002	2021-01-01
002	2020-01-01	KARL HAMM	2021-03-22
002	2019-01-01	KARL HAMM	2020-05-06
002	2018-01-01	KARL HAMM	2019-04-18
002	2017-01-01	KARL HAMM	2018-05-04
002	2016-01-01	KARL HAMM	2017-04-06
002	2015-01-01	KARL HAMM	2016-05-26
002	2014-01-01	SUSAN BROCK	2015-07-22
002	2013-01-01	SUSAN BROCK	2014-07-24
002	2012-01-01	SUSAN BROCK	2013-07-16
002	2011-01-01	SUSAN BROCK	2012-06-12
002	2010-01-01	SUSAN BROCK	2011-06-17

Plan Statistics for NASHVILLE DENTAL, INC. 401K PLAN

401k plan membership statisitcs for NASHVILLE DENTAL, INC. 401K PLAN

Measure Date Value
2023: NASHVILLE DENTAL, INC. 401K PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 127
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 9
Total of all active and inactive participants 2023-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 136
Number of participants with account balances 2023-01-01 132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 3
2022: NASHVILLE DENTAL, INC. 401K PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 123
Number of retired or separated participants receiving benefits 2022-01-01 4
Number of other retired or separated participants entitled to future benefits 2022-01-01 8
Total of all active and inactive participants 2022-01-01 135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 135
Number of participants with account balances 2022-01-01 133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 3
2021: NASHVILLE DENTAL, INC. 401K PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 118
Number of retired or separated participants receiving benefits 2021-01-01 1
Number of other retired or separated participants entitled to future benefits 2021-01-01 9
Total of all active and inactive participants 2021-01-01 128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 129
Number of participants with account balances 2021-01-01 126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 3

Measure	Date	Value
2023: NASHVILLE DENTAL, INC. 401K PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	127
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	9
Total of all active and inactive participants	2023-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	136
Number of participants with account balances	2023-01-01	132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	3
2022: NASHVILLE DENTAL, INC. 401K PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	123
Number of retired or separated participants receiving benefits	2022-01-01	4
Number of other retired or separated participants entitled to future benefits	2022-01-01	8
Total of all active and inactive participants	2022-01-01	135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	135
Number of participants with account balances	2022-01-01	133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	3
2021: NASHVILLE DENTAL, INC. 401K PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	118
Number of retired or separated participants receiving benefits	2021-01-01	1
Number of other retired or separated participants entitled to future benefits	2021-01-01	9
Total of all active and inactive participants	2021-01-01	128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	129
Number of participants with account balances	2021-01-01	126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	3

Financial Data on NASHVILLE DENTAL, INC. 401K PLAN

Measure	Date	Value
2023 : NASHVILLE DENTAL, INC. 401K PLAN 2023 401k financial data
Total unrealized appreciation/depreciation of assets	2023-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$49,341
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$38,928
Total income from all sources (including contributions)	2023-12-31	$2,722,532
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$1,134,332
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$1,055,631
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$921,330
Value of total assets at end of year	2023-12-31	$13,290,666
Value of total assets at beginning of year	2023-12-31	$11,692,053
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$78,701
Total interest from all sources	2023-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2023-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2023-12-31	No
Was this plan covered by a fidelity bond	2023-12-31	Yes
Value of fidelity bond cover	2023-12-31	$500,000
If this is an individual account plan, was there a blackout period	2023-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2023-12-31	No
Contributions received from participants	2023-12-31	$765,373
Assets. Other investments not covered elsewhere at end of year	2023-12-31	$126,770
Assets. Other investments not covered elsewhere at beginning of year	2023-12-31	$112,542
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$15,957
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2023-12-31	$49,341
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2023-12-31	$38,928
Other income not declared elsewhere	2023-12-31	$14,228
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2023-12-31	No
Value of net income/loss	2023-12-31	$1,588,200
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$13,241,325
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$11,653,125
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2023-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2023-12-31	No
Were any leases to which the plan was party in default or uncollectible	2023-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-12-31	$13,023,896
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-12-31	$11,439,511
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-12-31	$1,786,974
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2023-12-31	No
Was there a failure to transmit to the plan any participant contributions	2023-12-31	No
Has the plan failed to provide any benefit when due under the plan	2023-12-31	No
Contributions received in cash from employer	2023-12-31	$140,000
Employer contributions (assets) at end of year	2023-12-31	$140,000
Employer contributions (assets) at beginning of year	2023-12-31	$140,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$1,055,631
Did the plan have assets held for investment	2023-12-31	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	2023-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2023-12-31	No
Opinion of an independent qualified public accountant for this plan	2023-12-31	Unqualified
Accountancy firm name	2023-12-31	CHERRY BEKAERT LLP
Accountancy firm EIN	2023-12-31	560574444
2022 : NASHVILLE DENTAL, INC. 401K PLAN 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	$38,928
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$19,463
Total income from all sources (including contributions)	2022-12-31	$-1,641,738
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$1,855,185
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$1,775,585
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$870,910
Value of total assets at end of year	2022-12-31	$11,692,053
Value of total assets at beginning of year	2022-12-31	$15,169,511
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$79,600
Total interest from all sources	2022-12-31	$0
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	$500,000
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	$686,866
Assets. Other investments not covered elsewhere at end of year	2022-12-31	$112,542
Assets. Other investments not covered elsewhere at beginning of year	2022-12-31	$135,394
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$44,044
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$38,928
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$19,463
Other income not declared elsewhere	2022-12-31	$-22,852
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	$-3,496,923
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$11,653,125
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$15,150,048
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
Investment advisory and management fees	2022-12-31	$79,600
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$11,439,511
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$14,894,117
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-2,489,796
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	$140,000
Employer contributions (assets) at end of year	2022-12-31	$140,000
Employer contributions (assets) at beginning of year	2022-12-31	$140,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$1,775,585
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	CHERRY BEKAERT LLP
Accountancy firm EIN	2022-12-31	560574444
2021 : NASHVILLE DENTAL, INC. 401K PLAN 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	$19,463
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$17,524
Total income from all sources (including contributions)	2021-12-31	$2,537,727
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$1,578,023
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$1,483,228
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$882,391
Value of total assets at end of year	2021-12-31	$15,169,511
Value of total assets at beginning of year	2021-12-31	$14,207,868
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$94,795
Total interest from all sources	2021-12-31	$0
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	$661,989
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$135,394
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$119,721
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$80,402
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$19,463
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$17,524
Other income not declared elsewhere	2021-12-31	$15,673
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	$959,704
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$15,150,048
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$14,190,344
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
Investment advisory and management fees	2021-12-31	$94,795
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$14,894,117
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$13,948,147
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$1,639,663
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	$140,000
Employer contributions (assets) at end of year	2021-12-31	$140,000
Employer contributions (assets) at beginning of year	2021-12-31	$140,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$1,483,228
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	CHERRY BEKAERT LLP
Accountancy firm EIN	2021-12-31	560574444

Form 5500 Responses for NASHVILLE DENTAL, INC. 401K PLAN

2023: NASHVILLE DENTAL, INC. 401K PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: NASHVILLE DENTAL, INC. 401K PLAN 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 – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: NASHVILLE DENTAL, INC. 401K PLAN 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 – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

VP65468630

Policy instance

Insurance contract or identification number	VP65468630
Number of Individuals Covered	1
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $185
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	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

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

104647

Policy instance

Insurance contract or identification number	104647
Number of Individuals Covered	138
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $47,595
Total amount of fees paid to insurance company	USD $7,387
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	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

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

VP65468630

Policy instance

Insurance contract or identification number	VP65468630
Number of Individuals Covered	1
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $197
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	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 $197
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

104647

Policy instance

Insurance contract or identification number	104647
Number of Individuals Covered	132
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $48,807
Total amount of fees paid to insurance company	USD $6,267
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	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 $48,807
Insurance broker organization code?	3
Amount paid for insurance broker fees	6267
Additional information about fees paid to insurance broker	FEES AND COMPENSATION

PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 )

Policy contract number

VP65468630

Policy instance

Insurance contract or identification number	VP65468630
Number of Individuals Covered	1
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $191
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	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 $191
Insurance broker organization code?	3

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

104647

Policy instance

Insurance contract or identification number	104647
Number of Individuals Covered	129
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $57,369
Total amount of fees paid to insurance company	USD $10,130
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	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 $57,369
Insurance broker organization code?	3
Amount paid for insurance broker fees	10130
Additional information about fees paid to insurance broker	FEES AND COMPENSATION

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Company Name:	NASHVILLE DENTAL, INC.
Employer identification number (EIN):	620304640
NAIC Classification:	621510
NAIC Description:	Medical and Diagnostic Laboratories