401k Plan data: CAREPLUS BERGEN, INC. DENTAL AND VISION PLAN plan

CAREPLUS BERGEN, INC. DENTAL AND VISION PLAN 401k Plan overview

Plan Name	CAREPLUS BERGEN, INC. DENTAL AND VISION PLAN
Plan identification number	505

CAREPLUS BERGEN, INC. DENTAL AND VISION PLAN Benefits

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

401k Sponsoring company profile

CAREPLUS BERGEN, INC. has sponsored the creation of one or more 401k plans.

Company Name: CAREPLUS BERGEN, INC.

Employer identification number (EIN): 822081292

NAIC Classification: 622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAREPLUS BERGEN, INC. DENTAL AND VISION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
505 2017-10-01 CARRIE DEHLS

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
505	2017-10-01	CARRIE DEHLS

Plan Statistics for CAREPLUS BERGEN, INC. DENTAL AND VISION PLAN

401k plan membership statisitcs for CAREPLUS BERGEN, INC. DENTAL AND VISION PLAN

Measure Date Value
2017: CAREPLUS BERGEN, INC. DENTAL AND VISION PLAN 2017 401k membership
Total participants, beginning-of-year 2017-10-01 1,176
Total number of active participants reported on line 7a of the Form 5500 2017-10-01 1,198
Number of retired or separated participants receiving benefits 2017-10-01 5
Number of other retired or separated participants entitled to future benefits 2017-10-01 0
Total of all active and inactive participants 2017-10-01 1,203

Measure	Date	Value
2017: CAREPLUS BERGEN, INC. DENTAL AND VISION PLAN 2017 401k membership
Total participants, beginning-of-year	2017-10-01	1,176
Total number of active participants reported on line 7a of the Form 5500	2017-10-01	1,198
Number of retired or separated participants receiving benefits	2017-10-01	5
Number of other retired or separated participants entitled to future benefits	2017-10-01	0
Total of all active and inactive participants	2017-10-01	1,203

Form 5500 Responses for CAREPLUS BERGEN, INC. DENTAL AND VISION PLAN

2017: CAREPLUS BERGEN, INC. DENTAL AND VISION PLAN 2017 form 5500 responses
2017-10-01	Type of plan entity	Single employer plan
2017-10-01	First time form 5500 has been submitted	Yes
2017-10-01	Submission has been amended	No
2017-10-01	This submission is the final filing	No
2017-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-10-01	Plan is a collectively bargained plan	No
2017-10-01	Plan funding arrangement – Insurance	Yes
2017-10-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

ALPHA DENTAL PROGRAMS, INC. (National Association of Insurance Commissioners NAIC id number: 95163 )

Policy contract number

76969

Policy instance

Insurance contract or identification number	76969
Number of Individuals Covered	934
Insurance policy start date	2017-10-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $3,104
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 $103,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,104
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES (PA), INC.

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

03134

Policy instance

Insurance contract or identification number	03134
Number of Individuals Covered	1481
Insurance policy start date	2017-10-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $8,533
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,533
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES (PA), INC.

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0754163

Policy instance

Insurance contract or identification number	0754163
Number of Individuals Covered	964
Insurance policy start date	2017-10-01
Insurance policy end date	2018-05-31
Total amount of commissions paid to insurance broker	USD $7,885
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	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 $79,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,885
Insurance broker organization code?	3
Insurance broker name	NFP CORPORATE SERVICES (PA), INC.

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Company Name:	CAREPLUS BERGEN, INC.
Employer identification number (EIN):	822081292
NAIC Classification:	622000
NAIC Description:	Hospitals