MEWA-ECE Form
This Form is Open to Public Inspection
OMB No. 1210-0116
Department of Labor
Employee Benefits Security Administration
Complete as applicable:
09/28/2018
Kids Care Dental Group Welfare Benefits Plan
8950 Cal Center Dr.
Suite 363
Sacramento, CA 95826
(916) 661-5754
20-1299958
501
Don Yee
8950 Cal Center Dr.
Suite 363
Sacramento, CA 95826
20-1299958
kcdaccounting@kidscaredental.com
CDC Dental Management Co., LLC dba Kids Care Dental Group
8950 Cal Center Dr.
Suite 363
Sacramento, CA 95826
(916) 570-1500
20-1299958
Don Yee
CEO
8950 Cal Center Dr.
Suite 363
Sacramento, CA 95826
kcdaccounting@kidscaredental.com
Don Yee
CEO
8950 Cal Center Dr.
Suite 363
Sacramento, CA 95826
Joe Whitters
Board Member
8950 Cal Center Dr.
Suite 363
Sacramento, CA 95826
Kelly McCrann
Board Member
8950 Cal Center Dr.
Suite 363
Sacramento, CA 95826
Dan Hosler
Board Member
8950 Cal Center Dr.
Suite 363
Sacramento, CA 95826
Aaron Reeves
Board Member
8950 Cal Center Dr.
Suite 363
Sacramento, CA 95826
n/a
n/a
n/a
n/a
n/a
CDC Dental Management LLC
Board of Directors
8950 Cal Center Dr.
Suite 363
Sacramento, CA 95826
kcdaccounting@kidscaredental.com
20-1299958
CDC Dental Management, LLC
Benefit Plan Administration Committee
8950 Cal Center Dr.
Suite 363
Sacramento, CA 95826
kcdaccounting@kidscaredental.com
20-1299958
n/a
No
No
No
Yes
If no, please explain.
No
If yes, please identify each litigation or enforcement proceeding to include (if applicable): (1) the case number, (2) the date, (3) the nature of the proceedings, (4) the court, (5) all parties (for example, plaintiffs and defendants or petitioners and respondents), and (6) the disposition.
No
If yes, please explain.
No
Entity | Year |
---|
17a | 17b | 17c | 17d | 17e | 17f | 17g | 17h | 17i | 17j |
---|---|---|---|---|---|---|---|---|---|
Enter all States where the MEWA or ECE is operating. | Is coverage provided? | State registration number. | Name of state agent or entity for service of process. | Is the entity a licensed health insurer in this State? | If yes to 17e, enter NAIC number. | If no to 17e, is the entity fully insured? | If yes to 17g, enter name and NAIC number of insurer. | Does the entity purchase stop loss coverage? | If yes to 17i, enter the name and NAIC number of insurer. |
CA
Is new? |
Yes | n/a | n/a | No | n/a | Yes | CaliforniaChoice, 524292; United Healthcare, 79413; CoPower, 524210; UNUM, 62235 | No | n/a |
CA
85
N/A
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Under penalty of perjury and other penalties set forth in the instructions, I declare that I have examined this report, including any accompanying attachments, and to the best of my knowledge and belief, it is true and correct. Under penalty of perjury and other penalties set forth in the instructions, I also declare that, unless this is an extension request, this report is complete.