401k Plan data: COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN plan

COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN
Plan identification number	001

COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS 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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

COMMONWEALTH DENTAL GROUP has sponsored the creation of one or more 401k plans.

Company Name: COMMONWEALTH DENTAL GROUP

Employer identification number (EIN): 851192504

NAIC Classification: 621210
NAIC Description: Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01 DEBRA C. FISCUS 2024-10-15
001 2022-01-01 DEBRA C. FISCUS 2023-10-16
001 2021-01-01 DEBRA C. FISCUS 2022-10-14
001 2020-10-01

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2023-01-01	DEBRA C. FISCUS	2024-10-15
001	2022-01-01	DEBRA C. FISCUS	2023-10-16
001	2021-01-01	DEBRA C. FISCUS	2022-10-14
001	2020-10-01

Plan Statistics for COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN

Measure Date Value
2023: COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 375
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 312
Number of retired or separated participants receiving benefits 2023-01-01 4
Number of other retired or separated participants entitled to future benefits 2023-01-01 60
Total of all active and inactive participants 2023-01-01 376
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 376
Number of participants with account balances 2023-01-01 335
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 1
2022: COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 357
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 297
Number of retired or separated participants receiving benefits 2022-01-01 3
Number of other retired or separated participants entitled to future benefits 2022-01-01 58
Total of all active and inactive participants 2022-01-01 358
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 358
Number of participants with account balances 2022-01-01 308
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 1
2021: COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 342
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 311
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 48
Total of all active and inactive participants 2021-01-01 359
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 359
Number of participants with account balances 2021-01-01 312
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0

Measure	Date	Value
2023: COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	375
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	312
Number of retired or separated participants receiving benefits	2023-01-01	4
Number of other retired or separated participants entitled to future benefits	2023-01-01	60
Total of all active and inactive participants	2023-01-01	376
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	376
Number of participants with account balances	2023-01-01	335
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	1
2022: COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	357
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	297
Number of retired or separated participants receiving benefits	2022-01-01	3
Number of other retired or separated participants entitled to future benefits	2022-01-01	58
Total of all active and inactive participants	2022-01-01	358
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	358
Number of participants with account balances	2022-01-01	308
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	1
2021: COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	342
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	311
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	48
Total of all active and inactive participants	2021-01-01	359
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	359
Number of participants with account balances	2021-01-01	312
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0

Financial Data on COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN

Measure	Date	Value
2023 : COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2023-12-31	$0
Total income from all sources (including contributions)	2023-12-31	$3,569,816
Total loss/gain on sale of assets	2023-12-31	$0
Total of all expenses incurred	2023-12-31	$297,268
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2023-12-31	$241,288
Expenses. Certain deemed distributions of participant loans	2023-12-31	$5,894
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2023-12-31	$1,869,339
Value of total assets at end of year	2023-12-31	$11,921,191
Value of total assets at beginning of year	2023-12-31	$8,648,643
Total of administrative expenses incurred including professional, contract, advisory and management fees	2023-12-31	$50,086
Total interest from all sources	2023-12-31	$5,953
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	$1,197,857
Participant contributions at end of year	2023-12-31	$99,995
Participant contributions at beginning of year	2023-12-31	$88,463
Participant contributions at end of year	2023-12-31	$400
Participant contributions at beginning of year	2023-12-31	$680
Income. Received or receivable in cash from other sources (including rollovers)	2023-12-31	$104,921
Total non interest bearing cash at end of year	2023-12-31	$233
Total non interest bearing cash at beginning of year	2023-12-31	$233
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	$3,272,548
Value of net assets at end of year (total assets less liabilities)	2023-12-31	$11,921,191
Value of net assets at beginning of year (total assets less liabilities)	2023-12-31	$8,648,643
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
Investment advisory and management fees	2023-12-31	$18,940
Value of interest in registered invesment companies (eg mutual funds) at end of year	2023-12-31	$468,215
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2023-12-31	$381,445
Value of interest in pooled separate accounts at end of year	2023-12-31	$11,336,031
Value of interest in pooled separate accounts at beginning of year	2023-12-31	$8,160,756
Income. Interest from loans (other than to participants)	2023-12-31	$5,953
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2023-12-31	$1,694,524
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	$566,561
Employer contributions (assets) at end of year	2023-12-31	$16,317
Employer contributions (assets) at beginning of year	2023-12-31	$17,066
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2023-12-31	$241,288
Contract administrator fees	2023-12-31	$13,572
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	FAULKNER, KING & WENZ, PSC
Accountancy firm EIN	2023-12-31	611038574
2022 : COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS 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	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$172,185
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$365,375
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$326,435
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,724,356
Value of total assets at end of year	2022-12-31	$8,648,643
Value of total assets at beginning of year	2022-12-31	$8,841,833
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$38,940
Total interest from all sources	2022-12-31	$3,267
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
Administrative expenses professional fees incurred	2022-12-31	$38,940
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	$1,099,155
Participant contributions at end of year	2022-12-31	$88,463
Participant contributions at beginning of year	2022-12-31	$32,149
Participant contributions at end of year	2022-12-31	$680
Participant contributions at beginning of year	2022-12-31	$-7,061
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$68,962
Total non interest bearing cash at end of year	2022-12-31	$233
Total non interest bearing cash at beginning of year	2022-12-31	$0
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	$-193,190
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$8,648,643
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$8,841,833
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$381,445
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$470,385
Value of interest in pooled separate accounts at end of year	2022-12-31	$8,160,756
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$8,346,627
Income. Interest from loans (other than to participants)	2022-12-31	$3,267
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-1,555,438
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	$556,239
Employer contributions (assets) at end of year	2022-12-31	$17,066
Employer contributions (assets) at beginning of year	2022-12-31	$-267
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$326,435
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	FAULKNER, KING & WENZ, PSC
Accountancy firm EIN	2022-12-31	611038574
2021 : COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total transfer of assets to this plan	2021-12-31	$7,599,469
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$2,232,985
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$994,040
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$968,852
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$1,614,941
Value of total assets at end of year	2021-12-31	$8,841,833
Value of total assets at beginning of year	2021-12-31	$3,419
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$25,188
Total interest from all sources	2021-12-31	$1,709
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
Administrative expenses professional fees incurred	2021-12-31	$25,188
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	$1,057,258
Participant contributions at end of year	2021-12-31	$32,149
Participant contributions at beginning of year	2021-12-31	$0
Participant contributions at end of year	2021-12-31	$-7,061
Participant contributions at beginning of year	2021-12-31	$0
Total non interest bearing cash at end of year	2021-12-31	$0
Total non interest bearing cash at beginning of year	2021-12-31	$0
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	$1,238,945
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$8,841,833
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$3,419
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$470,385
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$0
Value of interest in pooled separate accounts at end of year	2021-12-31	$8,346,627
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$3,419
Interest on participant loans	2021-12-31	$1,709
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$616,335
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	$557,683
Employer contributions (assets) at end of year	2021-12-31	$-267
Employer contributions (assets) at beginning of year	2021-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$968,852
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	FAULKNER, KING & WENZ, PSC
Accountancy firm EIN	2021-12-31	611038574

Form 5500 Responses for COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS PLAN

2023: COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS 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 – Insurance	Yes
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS 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 – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: COMMONWEALTH DENTAL GROUP 401(K) RETIREMENT SAVINGS 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 – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

146998

Policy instance

Insurance contract or identification number	146998
Number of Individuals Covered	366
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $23,725
Total amount of fees paid to insurance company	USD $2,250
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?	Yes
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

146998

Policy instance

Insurance contract or identification number	146998
Number of Individuals Covered	346
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $19,541
Total amount of fees paid to insurance company	USD $1,650
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?	Yes
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 $15,608
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SALES/MARKETING
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

146998

Policy instance

Insurance contract or identification number	146998
Number of Individuals Covered	330
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $109,078
Total amount of fees paid to insurance company	USD $300
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 $78,320
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker organization code?	3

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Company Name:	COMMONWEALTH DENTAL GROUP
Employer identification number (EIN):	851192504
NAIC Classification:	621210
NAIC Description:	Offices of Dentists