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CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 401k Plan overview

Plan NameCHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN
Plan identification number 510

CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision

401k Sponsoring company profile

CHILDREN'S UNIVERSITY MEDICAL GROUP has sponsored the creation of one or more 401k plans.

Company Name:CHILDREN'S UNIVERSITY MEDICAL GROUP
Employer identification number (EIN):911336707
NAIC Classification:621112
NAIC Description:Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5102020-01-01PATTI ADAMICH2021-07-23
5102020-01-01PATTI ADAMICH2021-09-23
5102019-01-01PATTI ADAMICH2020-07-30
5102018-01-01
5102017-01-01
5102016-01-01PATTI ADAMICH PATTI ADAMICH2017-07-12
5102015-01-01PATTI ADAMICH PATTI ADAMICH2016-08-30
5102014-01-01PATTI ADAMICH PATTI ADAMICH2015-10-13
5102013-01-01PATTI ADAMICH PATTI ADAMICH2014-10-10
5102012-01-01PATTI ADAMICH
5102011-01-01PATTI ADAMICH
5102010-01-01PATTI ADAMICH
5102009-01-01PATTI ADAMICH PATTI ADAMICH2010-10-01

Plan Statistics for CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN

401k plan membership statisitcs for CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN

Measure Date Value
2020: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01409
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-010
Number of employers contributing to the scheme2020-01-010
2019: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01372
Total number of active participants reported on line 7a of the Form 55002019-01-01409
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01409
Number of employers contributing to the scheme2019-01-010
2018: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01350
Total number of active participants reported on line 7a of the Form 55002018-01-01372
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01372
Number of employers contributing to the scheme2018-01-010
2017: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01376
Total number of active participants reported on line 7a of the Form 55002017-01-01350
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01350
2016: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01345
Total number of active participants reported on line 7a of the Form 55002016-01-01376
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01376
2015: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01336
Total number of active participants reported on line 7a of the Form 55002015-01-01345
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01345
2014: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01327
Total number of active participants reported on line 7a of the Form 55002014-01-01336
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01336
2013: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01303
Total number of active participants reported on line 7a of the Form 55002013-01-01327
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01327
2012: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01290
Total number of active participants reported on line 7a of the Form 55002012-01-01303
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01303
2011: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01268
Total number of active participants reported on line 7a of the Form 55002011-01-01286
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01286
2010: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01246
Total number of active participants reported on line 7a of the Form 55002010-01-01266
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01266
2009: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01210
Total number of active participants reported on line 7a of the Form 55002009-01-01246
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01246

Form 5500 Responses for CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN

2020: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedYes
2020-01-01This submission is the final filingYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: CHILDRENS UNIVERSITY MEDICAL GROUP WA DENTAL SERVICE INS. PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number348
Policy instance 1
Insurance contract or identification number348
Number of Individuals Covered1172
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $9,192
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,192
Amount paid for insurance broker fees0
Insurance broker organization code?3
PREMERA BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 47570 )
Policy contract number4012768
Policy instance 2
Insurance contract or identification number4012768
Number of Individuals Covered1057
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $52,751
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,890,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,751
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number348
Policy instance 1
Insurance contract or identification number348
Number of Individuals Covered1155
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $8,750
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,750
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number348
Policy instance 1
Insurance contract or identification number348
Number of Individuals Covered1072
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $8,144
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $8,144
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF WASHINGTON (National Association of Insurance Commissioners NAIC id number: 47341 )
Policy contract number00348
Policy instance 1
Insurance contract or identification number00348
Number of Individuals Covered1035
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $8,445
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $8,445
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameALLIANT INSURANCE SERVICES, INC.

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