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ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 401k Plan overview

Plan NameORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN
Plan identification number 001

ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • 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.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND, P.A. has sponsored the creation of one or more 401k plans.

Company Name:ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND, P.A.
Employer identification number (EIN):520892523
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012019-01-01
0012018-01-01
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01
0012013-01-01STEPHEN D MADDOCK
0012012-01-01STEPHEN D. MADDOCK
0012011-01-01STEPHEN D. MADDOCK
0012010-01-01STEPHEN D MADDOCK2011-10-14 STEPHEN D MADDOCK2011-10-14

Plan Statistics for ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN

401k plan membership statisitcs for ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN

Measure Date Value
2016: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0118
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0115
Total of all active and inactive participants2016-01-0115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0115
Number of participants with account balances2016-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0131
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0117
Total of all active and inactive participants2015-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0117
Number of participants with account balances2015-01-0117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0139
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0132
Total of all active and inactive participants2014-01-0132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0132
Number of participants with account balances2014-01-0132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01109
Total number of active participants reported on line 7a of the Form 55002013-01-0113
Number of retired or separated participants receiving benefits2013-01-017
Number of other retired or separated participants entitled to future benefits2013-01-0118
Total of all active and inactive participants2013-01-0138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0138
Number of participants with account balances2013-01-0138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-019
2012: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01107
Total number of active participants reported on line 7a of the Form 55002012-01-0186
Number of retired or separated participants receiving benefits2012-01-015
Number of other retired or separated participants entitled to future benefits2012-01-0117
Total of all active and inactive participants2012-01-01108
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01108
Number of participants with account balances2012-01-01107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-0110
2011: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01117
Total number of active participants reported on line 7a of the Form 55002011-01-0182
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0123
Total of all active and inactive participants2011-01-01105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01105
Number of participants with account balances2011-01-01105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-018

Financial Data on ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN

Measure Date Value
2016 : ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2016 401k financial data
Total income from all sources2016-12-31$93,832
Expenses. Total of all expenses incurred2016-12-31$128,711
Benefits paid (including direct rollovers)2016-12-31$128,494
Total plan assets at end of year2016-12-31$592,807
Total plan assets at beginning of year2016-12-31$627,686
Value of fidelity bond covering the plan2016-12-31$500,000
Other income received2016-12-31$93,832
Net income (gross income less expenses)2016-12-31$-34,879
Net plan assets at end of year (total assets less liabilities)2016-12-31$592,807
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$627,686
Assets. Value of assets in partnership/joint-venture interests2016-12-31$482,584
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$217
2015 : ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$846
Total income from all sources2015-12-31$115,574
Expenses. Total of all expenses incurred2015-12-31$10,586,317
Benefits paid (including direct rollovers)2015-12-31$10,585,817
Total plan assets at end of year2015-12-31$627,686
Total plan assets at beginning of year2015-12-31$11,099,275
Value of fidelity bond covering the plan2015-12-31$500,000
Other income received2015-12-31$115,574
Net income (gross income less expenses)2015-12-31$-10,470,743
Net plan assets at end of year (total assets less liabilities)2015-12-31$627,686
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$11,098,429
Assets. Value of assets in partnership/joint-venture interests2015-12-31$482,584
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$500
2014 : ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2014 401k financial data
Total plan liabilities at end of year2014-12-31$846
Total plan liabilities at beginning of year2014-12-31$846
Total income from all sources2014-12-31$794,143
Expenses. Total of all expenses incurred2014-12-31$695,448
Benefits paid (including direct rollovers)2014-12-31$694,938
Total plan assets at end of year2014-12-31$11,099,275
Total plan assets at beginning of year2014-12-31$11,000,580
Value of fidelity bond covering the plan2014-12-31$500,000
Other income received2014-12-31$794,143
Net income (gross income less expenses)2014-12-31$98,695
Net plan assets at end of year (total assets less liabilities)2014-12-31$11,098,429
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$10,999,734
Assets. Value of assets in partnership/joint-venture interests2014-12-31$482,584
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022014-12-31$1,125
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$510
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2013 401k financial data
Total plan liabilities at end of year2013-12-31$846
Total plan liabilities at beginning of year2013-12-31$196
Total income from all sources2013-12-31$3,228,249
Expenses. Total of all expenses incurred2013-12-31$2,470,102
Benefits paid (including direct rollovers)2013-12-31$2,393,318
Total plan assets at end of year2013-12-31$11,000,580
Total plan assets at beginning of year2013-12-31$10,241,783
Value of fidelity bond covering the plan2013-12-31$500,000
Total contributions received or receivable from participants2013-12-31$222,500
Contributions received from other sources (not participants or employers)2013-12-31$20,674
Other income received2013-12-31$2,839,459
Net income (gross income less expenses)2013-12-31$758,147
Net plan assets at end of year (total assets less liabilities)2013-12-31$10,999,734
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$10,241,587
Assets. Value of participant loans2013-12-31$173,889
Assets. Value of assets in partnership/joint-venture interests2013-12-31$482,584
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022013-12-31$1,125
Total contributions received or receivable from employer(s)2013-12-31$145,616
Value of certain deemed distributions of participant loans2013-12-31$72,448
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$4,336
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2012 401k financial data
Total plan liabilities at end of year2012-12-31$196
Total income from all sources2012-12-31$2,361,339
Expenses. Total of all expenses incurred2012-12-31$577,029
Benefits paid (including direct rollovers)2012-12-31$565,870
Total plan assets at end of year2012-12-31$10,241,783
Total plan assets at beginning of year2012-12-31$8,457,277
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$350,392
Contributions received from other sources (not participants or employers)2012-12-31$110,339
Other income received2012-12-31$1,496,316
Net income (gross income less expenses)2012-12-31$1,784,310
Net plan assets at end of year (total assets less liabilities)2012-12-31$10,241,587
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$8,457,277
Assets. Value of participant loans2012-12-31$293,023
Assets. Value of assets in partnership/joint-venture interests2012-12-31$482,584
Total contributions received or receivable from employer(s)2012-12-31$404,292
Value of certain deemed distributions of participant loans2012-12-31$1,689
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$9,470
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2011 401k financial data
Total plan liabilities at beginning of year2011-12-31$239
Total income from all sources2011-12-31$-532,153
Expenses. Total of all expenses incurred2011-12-31$189,730
Benefits paid (including direct rollovers)2011-12-31$170,347
Total plan assets at end of year2011-12-31$8,457,277
Total plan assets at beginning of year2011-12-31$9,179,399
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$326,526
Contributions received from other sources (not participants or employers)2011-12-31$51,364
Other income received2011-12-31$-1,306,396
Net income (gross income less expenses)2011-12-31$-721,883
Net plan assets at end of year (total assets less liabilities)2011-12-31$8,457,277
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$9,179,160
Assets. Value of participant loans2011-12-31$109,113
Assets. Value of assets in partnership/joint-venture interests2011-12-31$482,584
Total contributions received or receivable from employer(s)2011-12-31$396,353
Value of certain deemed distributions of participant loans2011-12-31$1,630
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$17,753
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0

Form 5500 Responses for ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN

2016: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT 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 funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT 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 funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT 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 funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT 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 funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT 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 funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: ORTHOPAEDIC ASSOCIATES OF CENTRAL MARYLAND P.A. 401(K) RETIREMENT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
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 funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number17566
Policy instance 1
Insurance contract or identification number17566
Number of Individuals Covered8
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $9,477
Total amount of fees paid to insurance companyUSD $1,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,477
Insurance broker organization code?3
Amount paid for insurance broker fees1923
Additional information about fees paid to insurance brokerTPA COMPENSATION, OTHER ALLOWANCES
Insurance broker nameNEWPORT GROUP, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number17566
Policy instance 1
Insurance contract or identification number17566
Number of Individuals Covered26
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $9,975
Total amount of fees paid to insurance companyUSD $2,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,975
Insurance broker organization code?3
Amount paid for insurance broker fees2515
Additional information about fees paid to insurance brokerTPA FEES PAID, TPA COMPENSATION, AND OTHER ALLOWANCES
Insurance broker nameVERISIGHT, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number17566
Policy instance 1
Insurance contract or identification number17566
Number of Individuals Covered31
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $10,075
Total amount of fees paid to insurance companyUSD $6,242
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $10,075
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?4
Amount paid for insurance broker fees6242
Insurance broker nameVERISIGHT, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number17566
Policy instance 1
Insurance contract or identification number17566
Number of Individuals Covered97
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $13,945
Total amount of fees paid to insurance companyUSD $5,358
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $13,945
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?4
Amount paid for insurance broker fees5358
Insurance broker nameVERISIGHT, INC.
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number17566
Policy instance 1
Insurance contract or identification number17566
Number of Individuals Covered98
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $14,660
Total amount of fees paid to insurance companyUSD $4,473
Are there contracts with allocated funds for individual policies?No
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No

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