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| Plan Name | CHILD CRISIS ARIZONA GROUP DENTAL INSURANCE PLAN |
| Plan identification number | 502 |
| 401k Plan Type | Welfare Benefit |
| Plan Features/Benefits |
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| Company Name: | CHILD CRISIS ARIZONA |
| Employer identification number (EIN): | 860324144 |
| NAIC Classification: | 624200 |
| Plan id# | Filing Submission Date | Name of Administrator | Date Administrator Signed | Name of Company Sponsor | Date Sponsor Signed |
|---|---|---|---|---|---|
| 502 | 2016-04-01 | LISA RICCI | LISA RICCI | 2017-08-07 | |
| 502 | 2016-04-01 | ||||
| 502 | 2015-04-01 | LISA RICCI | LISA RICCI | 2016-11-10 |
| 2016: CHILD CRISIS ARIZONA GROUP DENTAL INSURANCE PLAN 2016 form 5500 responses | ||
|---|---|---|
| 2016-04-01 | Type of plan entity | Single employer plan |
| 2016-04-01 | Submission has been amended | No |
| 2016-04-01 | This submission is the final filing | No |
| 2016-04-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2016-04-01 | Plan is a collectively bargained plan | No |
| 2016-04-01 | Plan funding arrangement – Insurance | Yes |
| 2016-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: CHILD CRISIS ARIZONA GROUP DENTAL INSURANCE PLAN 2015 form 5500 responses | ||
| 2015-04-01 | Type of plan entity | Single employer plan |
| 2015-04-01 | First time form 5500 has been submitted | Yes |
| 2015-04-01 | Submission has been amended | No |
| 2015-04-01 | This submission is the final filing | No |
| 2015-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-04-01 | Plan is a collectively bargained plan | No |
| 2015-04-01 | Plan funding arrangement – Insurance | Yes |
| 2015-04-01 | Plan benefit arrangement – Insurance | Yes |
| UNION DENTAL CARE OF ARIZONA, INC. (National Association of Insurance Commissioners NAIC id number: 47708 ) | |
| Policy contract number | 5476063 |
| Policy instance | 1 |
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) | |
| Policy contract number | 5476063 |
| Policy instance | 2 |
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