401k Plan data: ALAN BURWINKEL MD PROFIT SHARING PLAN plan

ALAN BURWINKEL MD PROFIT SHARING PLAN 401k Plan overview

Plan Name	ALAN BURWINKEL MD PROFIT SHARING PLAN
Plan identification number	001

ALAN BURWINKEL MD PROFIT SHARING 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.
Participant-directed brokerage accounts provided as an investment option under the plan.
Plan covering Self-Employed individuals.
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.

401k Sponsoring company profile

ALAN BURWINKEL MD has sponsored the creation of one or more 401k plans.

Company Name: ALAN BURWINKEL MD

Employer identification number (EIN): 311064859

NAIC Classification: 621111
NAIC Description: Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALAN BURWINKEL MD PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01
001 2020-01-01
001 2018-01-01 ALAN G BURWINKEL ALAN G BURWINKEL 2019-02-19
001 2017-01-01 ALAN G BURWINKEL ALAN G BURWINKEL 2018-05-01
001 2016-01-01 ALAN G BURWINKEL ALAN G BURWINKEL 2017-07-18
001 2015-01-01 ALAN G BURWINKEL ALAN G BURWINKEL 2016-09-07
001 2014-01-01 ALAN G BURWINKEL ALAN G BURWINKEL 2015-07-28
001 2013-01-01 ALAN G BURWINKEL ALAN G BURWINKEL 2014-03-17
001 2012-01-01 ALAN G BURWINKEL ALAN G BURWINKEL 2013-04-15
001 2011-01-01 ALAN G BURWINKEL ALAN G BURWINKEL 2012-05-15
001 2010-01-01 ALAN G BURWINKEL 2011-07-25 ALAN G BURWINKEL 2011-07-25

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-01-01
001	2020-01-01
001	2018-01-01	ALAN G BURWINKEL		ALAN G BURWINKEL	2019-02-19
001	2017-01-01	ALAN G BURWINKEL		ALAN G BURWINKEL	2018-05-01
001	2016-01-01	ALAN G BURWINKEL		ALAN G BURWINKEL	2017-07-18
001	2015-01-01	ALAN G BURWINKEL		ALAN G BURWINKEL	2016-09-07
001	2014-01-01	ALAN G BURWINKEL		ALAN G BURWINKEL	2015-07-28
001	2013-01-01	ALAN G BURWINKEL		ALAN G BURWINKEL	2014-03-17
001	2012-01-01	ALAN G BURWINKEL		ALAN G BURWINKEL	2013-04-15
001	2011-01-01	ALAN G BURWINKEL		ALAN G BURWINKEL	2012-05-15
001	2010-01-01	ALAN G BURWINKEL	2011-07-25	ALAN G BURWINKEL	2011-07-25

Plan Statistics for ALAN BURWINKEL MD PROFIT SHARING PLAN

401k plan membership statisitcs for ALAN BURWINKEL MD PROFIT SHARING PLAN

Measure Date Value
2021: ALAN BURWINKEL MD PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 1
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 0
Total participants 2021-01-01 0
Number of participants with account balances 2021-01-01 0
2020: ALAN BURWINKEL MD PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 1
Number of other retired or separated participants entitled to future benefits 2020-01-01 1
Total of all active and inactive participants 2020-01-01 1
Total participants 2020-01-01 1
Number of participants with account balances 2020-01-01 1
2018: ALAN BURWINKEL MD PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 2
Number of other retired or separated participants entitled to future benefits 2018-01-01 1
Total of all active and inactive participants 2018-01-01 3
Total participants 2018-01-01 3
Number of participants with account balances 2018-01-01 3
2017: ALAN BURWINKEL MD PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 2
Number of other retired or separated participants entitled to future benefits 2017-01-01 1
Total of all active and inactive participants 2017-01-01 3
Total participants 2017-01-01 3
Number of participants with account balances 2017-01-01 3
2016: ALAN BURWINKEL MD PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 2
Number of other retired or separated participants entitled to future benefits 2016-01-01 1
Total of all active and inactive participants 2016-01-01 3
Total participants 2016-01-01 3
Number of participants with account balances 2016-01-01 3
2015: ALAN BURWINKEL MD PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 2
Number of other retired or separated participants entitled to future benefits 2015-01-01 1
Total of all active and inactive participants 2015-01-01 3
Total participants 2015-01-01 3
Number of participants with account balances 2015-01-01 3
2014: ALAN BURWINKEL MD PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 2
Number of other retired or separated participants entitled to future benefits 2014-01-01 2
Total of all active and inactive participants 2014-01-01 4
Total participants 2014-01-01 4
Number of participants with account balances 2014-01-01 4
2013: ALAN BURWINKEL MD PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 2
Number of other retired or separated participants entitled to future benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 4
Total participants 2013-01-01 4
Number of participants with account balances 2013-01-01 4
2012: ALAN BURWINKEL MD PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2
Number of other retired or separated participants entitled to future benefits 2012-01-01 7
Total of all active and inactive participants 2012-01-01 9
Total participants 2012-01-01 9
Number of participants with account balances 2012-01-01 9
2011: ALAN BURWINKEL MD PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 2
Number of other retired or separated participants entitled to future benefits 2011-01-01 7
Total of all active and inactive participants 2011-01-01 9
Total participants 2011-01-01 9
Number of participants with account balances 2011-01-01 9

Measure	Date	Value
2021: ALAN BURWINKEL MD PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	1
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	0
Total participants	2021-01-01	0
Number of participants with account balances	2021-01-01	0
2020: ALAN BURWINKEL MD PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	1
Number of other retired or separated participants entitled to future benefits	2020-01-01	1
Total of all active and inactive participants	2020-01-01	1
Total participants	2020-01-01	1
Number of participants with account balances	2020-01-01	1
2018: ALAN BURWINKEL MD PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	2
Number of other retired or separated participants entitled to future benefits	2018-01-01	1
Total of all active and inactive participants	2018-01-01	3
Total participants	2018-01-01	3
Number of participants with account balances	2018-01-01	3
2017: ALAN BURWINKEL MD PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	2
Number of other retired or separated participants entitled to future benefits	2017-01-01	1
Total of all active and inactive participants	2017-01-01	3
Total participants	2017-01-01	3
Number of participants with account balances	2017-01-01	3
2016: ALAN BURWINKEL MD PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	2
Number of other retired or separated participants entitled to future benefits	2016-01-01	1
Total of all active and inactive participants	2016-01-01	3
Total participants	2016-01-01	3
Number of participants with account balances	2016-01-01	3
2015: ALAN BURWINKEL MD PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	2
Number of other retired or separated participants entitled to future benefits	2015-01-01	1
Total of all active and inactive participants	2015-01-01	3
Total participants	2015-01-01	3
Number of participants with account balances	2015-01-01	3
2014: ALAN BURWINKEL MD PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	2
Number of other retired or separated participants entitled to future benefits	2014-01-01	2
Total of all active and inactive participants	2014-01-01	4
Total participants	2014-01-01	4
Number of participants with account balances	2014-01-01	4
2013: ALAN BURWINKEL MD PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	4
Total participants	2013-01-01	4
Number of participants with account balances	2013-01-01	4
2012: ALAN BURWINKEL MD PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2
Number of other retired or separated participants entitled to future benefits	2012-01-01	7
Total of all active and inactive participants	2012-01-01	9
Total participants	2012-01-01	9
Number of participants with account balances	2012-01-01	9
2011: ALAN BURWINKEL MD PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	2
Number of other retired or separated participants entitled to future benefits	2011-01-01	7
Total of all active and inactive participants	2011-01-01	9
Total participants	2011-01-01	9
Number of participants with account balances	2011-01-01	9

Financial Data on ALAN BURWINKEL MD PROFIT SHARING PLAN

Measure	Date	Value
2021 : ALAN BURWINKEL MD PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources	2021-12-31	$5,246
Expenses. Total of all expenses incurred	2021-12-31	$45,367
Benefits paid (including direct rollovers)	2021-12-31	$45,367
Total plan assets at end of year	2021-12-31	$0
Total plan assets at beginning of year	2021-12-31	$40,121
Value of fidelity bond covering the plan	2021-12-31	$50,000
Other income received	2021-12-31	$5,246
Net income (gross income less expenses)	2021-12-31	$-40,121
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$40,121
2020 : ALAN BURWINKEL MD PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources	2020-12-31	$4,802
Total plan assets at end of year	2020-12-31	$40,121
Total plan assets at beginning of year	2020-12-31	$35,319
Value of fidelity bond covering the plan	2020-12-31	$50,000
Other income received	2020-12-31	$4,802
Net income (gross income less expenses)	2020-12-31	$4,802
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$40,121
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$35,319
2019 : ALAN BURWINKEL MD PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$7,905
Expenses. Total of all expenses incurred	2019-12-31	$269,896
Benefits paid (including direct rollovers)	2019-12-31	$269,896
Total plan assets at end of year	2019-12-31	$35,319
Total plan assets at beginning of year	2019-12-31	$297,310
Value of fidelity bond covering the plan	2019-12-31	$50,000
Other income received	2019-12-31	$7,905
Net income (gross income less expenses)	2019-12-31	$-261,991
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$35,319
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$297,310
2018 : ALAN BURWINKEL MD PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$12,719
Expenses. Total of all expenses incurred	2018-12-31	$328,880
Benefits paid (including direct rollovers)	2018-12-31	$328,880
Total plan assets at end of year	2018-12-31	$297,310
Total plan assets at beginning of year	2018-12-31	$613,471
Value of fidelity bond covering the plan	2018-12-31	$50,000
Other income received	2018-12-31	$12,719
Net income (gross income less expenses)	2018-12-31	$-316,161
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$297,310
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$613,471
2017 : ALAN BURWINKEL MD PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$154,291
Expenses. Total of all expenses incurred	2017-12-31	$917,177
Benefits paid (including direct rollovers)	2017-12-31	$917,177
Total plan assets at end of year	2017-12-31	$613,471
Total plan assets at beginning of year	2017-12-31	$1,376,357
Value of fidelity bond covering the plan	2017-12-31	$70,000
Total contributions received or receivable from participants	2017-12-31	$48,000
Other income received	2017-12-31	$54,966
Net income (gross income less expenses)	2017-12-31	$-762,886
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$613,471
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$1,376,357
Total contributions received or receivable from employer(s)	2017-12-31	$51,325
2016 : ALAN BURWINKEL MD PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$174,269
Total plan assets at end of year	2016-12-31	$1,376,357
Total plan assets at beginning of year	2016-12-31	$1,202,088
Value of fidelity bond covering the plan	2016-12-31	$150,000
Total contributions received or receivable from participants	2016-12-31	$48,000
Other income received	2016-12-31	$76,431
Net income (gross income less expenses)	2016-12-31	$174,269
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,376,357
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,202,088
Total contributions received or receivable from employer(s)	2016-12-31	$49,838
2015 : ALAN BURWINKEL MD PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$36,230
Expenses. Total of all expenses incurred	2015-12-31	$30,217
Benefits paid (including direct rollovers)	2015-12-31	$30,217
Total plan assets at end of year	2015-12-31	$1,202,088
Total plan assets at beginning of year	2015-12-31	$1,196,075
Value of fidelity bond covering the plan	2015-12-31	$120,000
Total contributions received or receivable from participants	2015-12-31	$24,000
Other income received	2015-12-31	$-34,712
Net income (gross income less expenses)	2015-12-31	$6,013
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,202,088
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,196,075
Total contributions received or receivable from employer(s)	2015-12-31	$46,942
2014 : ALAN BURWINKEL MD PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$141,209
Total plan assets at end of year	2014-12-31	$1,196,075
Total plan assets at beginning of year	2014-12-31	$1,054,866
Value of fidelity bond covering the plan	2014-12-31	$120,000
Total contributions received or receivable from participants	2014-12-31	$46,000
Other income received	2014-12-31	$46,869
Net income (gross income less expenses)	2014-12-31	$141,209
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,196,075
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,054,866
Total contributions received or receivable from employer(s)	2014-12-31	$48,340
2013 : ALAN BURWINKEL MD PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$41,665
Expenses. Total of all expenses incurred	2013-12-31	$227,110
Benefits paid (including direct rollovers)	2013-12-31	$227,110
Total plan assets at end of year	2013-12-31	$1,054,866
Total plan assets at beginning of year	2013-12-31	$1,240,311
Value of fidelity bond covering the plan	2013-12-31	$100,000
Total contributions received or receivable from participants	2013-12-31	$46,000
Other income received	2013-12-31	$-47,522
Net income (gross income less expenses)	2013-12-31	$-185,445
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,054,866
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,240,311
Total contributions received or receivable from employer(s)	2013-12-31	$43,187
2012 : ALAN BURWINKEL MD PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$129,008
Total plan assets at end of year	2012-12-31	$1,240,311
Total plan assets at beginning of year	2012-12-31	$1,111,303
Value of fidelity bond covering the plan	2012-12-31	$130,000
Total contributions received or receivable from participants	2012-12-31	$45,000
Other income received	2012-12-31	$40,336
Net income (gross income less expenses)	2012-12-31	$129,008
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,240,311
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,111,303
Total contributions received or receivable from employer(s)	2012-12-31	$43,672
2011 : ALAN BURWINKEL MD PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$104,957
Expenses. Total of all expenses incurred	2011-12-31	$7,983
Benefits paid (including direct rollovers)	2011-12-31	$7,983
Total plan assets at end of year	2011-12-31	$1,111,303
Total plan assets at beginning of year	2011-12-31	$1,014,329
Value of fidelity bond covering the plan	2011-12-31	$110,000
Total contributions received or receivable from participants	2011-12-31	$44,000
Other income received	2011-12-31	$10,662
Net income (gross income less expenses)	2011-12-31	$96,974
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,111,303
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,014,329
Total contributions received or receivable from employer(s)	2011-12-31	$50,295

Form 5500 Responses for ALAN BURWINKEL MD PROFIT SHARING PLAN

2021: ALAN BURWINKEL MD PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	This submission is the final filing	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: ALAN BURWINKEL MD PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2018: ALAN BURWINKEL MD PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: ALAN BURWINKEL MD PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: ALAN BURWINKEL MD PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: ALAN BURWINKEL MD PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: ALAN BURWINKEL MD PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: ALAN BURWINKEL MD PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: ALAN BURWINKEL MD PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: ALAN BURWINKEL MD PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )

Policy contract number

6075156

Policy instance

Insurance contract or identification number	6075156
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )

Policy contract number

6075156

Policy instance

Insurance contract or identification number	6075156
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )

Policy contract number

6075156

Policy instance

Insurance contract or identification number	6075156
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )

Policy contract number

6075156

Policy instance

Insurance contract or identification number	6075156
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	DOUGLAS MORTON MCKINNEY CFP

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )

Policy contract number

6075156

Policy instance

Insurance contract or identification number	6075156
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	DOUGLAS MORTON MCKINNEY CFP

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )

Policy contract number

6075156

Policy instance

Insurance contract or identification number	6075156
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	DOUGLAS MORTON MCKINNEY CFP

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )

Policy contract number

6075156

Policy instance

Insurance contract or identification number	6075156
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	DOUGLAS MORTON MCKINNEY CFP

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )

Policy contract number

6075156

Policy instance

Insurance contract or identification number	6075156
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	DOUGLAS MORTON MCKINNEY CFP

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )

Policy contract number

6075156

Policy instance

Insurance contract or identification number	6075156
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ALAN BURWINKEL MD
Employer identification number (EIN):	311064859
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)