401k Plan data: MICROMODE PRODUCTS GROUP DENTAL INSURANCE plan

MICROMODE PRODUCTS GROUP DENTAL INSURANCE 401k Plan overview

Plan Name	MICROMODE PRODUCTS GROUP DENTAL INSURANCE
Plan identification number	502

MICROMODE PRODUCTS GROUP DENTAL INSURANCE Benefits

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

401k Sponsoring company profile

MICRO-MODE PRODUCTS, INC has sponsored the creation of one or more 401k plans.

Company Name: MICRO-MODE PRODUCTS, INC

Employer identification number (EIN): 952679867

NAIC Classification: 334410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MICROMODE PRODUCTS GROUP DENTAL INSURANCE

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2021-09-01
502 2021-09-01

Plan Statistics for MICROMODE PRODUCTS GROUP DENTAL INSURANCE

401k plan membership statisitcs for MICROMODE PRODUCTS GROUP DENTAL INSURANCE

Measure Date Value
2021: MICROMODE PRODUCTS GROUP DENTAL INSURANCE 2021 401k membership
Total participants, beginning-of-year 2021-09-01 113
Total number of active participants reported on line 7a of the Form 5500 2021-09-01 111
Number of retired or separated participants receiving benefits 2021-09-01 0
Number of other retired or separated participants entitled to future benefits 2021-09-01 0
Total of all active and inactive participants 2021-09-01 111
Total participants 2021-09-01 111

Measure	Date	Value
2021: MICROMODE PRODUCTS GROUP DENTAL INSURANCE 2021 401k membership
Total participants, beginning-of-year	2021-09-01	113
Total number of active participants reported on line 7a of the Form 5500	2021-09-01	111
Number of retired or separated participants receiving benefits	2021-09-01	0
Number of other retired or separated participants entitled to future benefits	2021-09-01	0
Total of all active and inactive participants	2021-09-01	111
Total participants	2021-09-01	111

Form 5500 Responses for MICROMODE PRODUCTS GROUP DENTAL INSURANCE

2021: MICROMODE PRODUCTS GROUP DENTAL INSURANCE 2021 form 5500 responses
2021-09-01	Type of plan entity	Single employer plan
2021-09-01	First time form 5500 has been submitted	Yes
2021-09-01	Submission has been amended	No
2021-09-01	This submission is the final filing	No
2021-09-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-09-01	Plan is a collectively bargained plan	No
2021-09-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-09-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

0149920

Policy instance

Insurance contract or identification number	0149920
Number of Individuals Covered	194
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $11,455
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	Yes
Dental Insurance Welfare Benefit	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,605
Amount paid for insurance broker fees	0

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 )

Policy contract number

149920

Policy instance

Insurance contract or identification number	149920
Number of Individuals Covered	111
Insurance policy start date	2021-09-01
Insurance policy end date	2022-08-31
Total amount of commissions paid to insurance broker	USD $1,146
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 $28,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $985
Insurance broker organization code?	3

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Company Name:	MICRO-MODE PRODUCTS, INC
Employer identification number (EIN):	952679867
NAIC Classification:	334410