401k Plan data: JOEL M. CORWIN, MD, APC 401(K) P/S PLAN plan

JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 401k Plan overview

Plan Name	JOEL M. CORWIN, MD, APC 401(K) P/S PLAN
Plan identification number	002

JOEL M. CORWIN, MD, APC 401(K) P/S PLAN Benefits

401k Plan Type

Defined 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.
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

MIRAMAR EYE SPECIALISTS MEDICAL GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: MIRAMAR EYE SPECIALISTS MEDICAL GROUP, INC.

Employer identification number (EIN): 770019313

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOEL M. CORWIN, MD, APC 401(K) P/S PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-04-01 JOEL M CORWIN MD 2023-03-10 JOEL M CORWIN MD 2023-03-10
002 2021-04-01 JOEL M. CORWIN, M.D. 2023-01-07 JOEL M. CORWIN, M.D. 2023-01-07
002 2020-04-01 DESIREE CALLAWAY 2021-11-09 DESIREE CALLAWAY 2021-11-09
002 2019-04-01
002 2018-04-01
002 2017-04-01
002 2016-04-01
002 2015-04-01
002 2014-04-01 DESIREE CALLAWAY 2015-09-10
002 2013-04-01 DESIREE CALLAWAY 2014-12-10
002 2012-04-01 JOEL M CORWIN MD 2013-10-16
002 2011-04-01 JOEL M CORWIN, MD 2012-10-09 JOEL M CORWIN, MD 2012-10-09
002 2010-04-01 JOEL CORWIN 2011-10-04

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-04-01	JOEL M CORWIN MD	2023-03-10	JOEL M CORWIN MD	2023-03-10
002	2021-04-01	JOEL M. CORWIN, M.D.	2023-01-07	JOEL M. CORWIN, M.D.	2023-01-07
002	2020-04-01	DESIREE CALLAWAY	2021-11-09	DESIREE CALLAWAY	2021-11-09
002	2019-04-01
002	2018-04-01
002	2017-04-01
002	2016-04-01
002	2015-04-01
002	2014-04-01	DESIREE CALLAWAY	2015-09-10
002	2013-04-01	DESIREE CALLAWAY	2014-12-10
002	2012-04-01	JOEL M CORWIN MD	2013-10-16
002	2011-04-01	JOEL M CORWIN, MD	2012-10-09	JOEL M CORWIN, MD	2012-10-09
002	2010-04-01	JOEL CORWIN	2011-10-04

Plan Statistics for JOEL M. CORWIN, MD, APC 401(K) P/S PLAN

401k plan membership statisitcs for JOEL M. CORWIN, MD, APC 401(K) P/S PLAN

Measure Date Value
2022: JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 2022 401k membership
Total participants, beginning-of-year 2022-04-01 133
Total number of active participants reported on line 7a of the Form 5500 2022-04-01 0
Number of retired or separated participants receiving benefits 2022-04-01 0
Number of other retired or separated participants entitled to future benefits 2022-04-01 0
Total of all active and inactive participants 2022-04-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-04-01 0
Total participants 2022-04-01 0
Number of participants with account balances 2022-04-01 0
2021: JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 2021 401k membership
Total participants, beginning-of-year 2021-04-01 166
Total number of active participants reported on line 7a of the Form 5500 2021-04-01 133
Number of retired or separated participants receiving benefits 2021-04-01 0
Number of other retired or separated participants entitled to future benefits 2021-04-01 13
Total of all active and inactive participants 2021-04-01 146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-04-01 0
Total participants 2021-04-01 146
Number of participants with account balances 2021-04-01 105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-04-01 0
2020: JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 2020 401k membership
Total participants, beginning-of-year 2020-04-01 132
Total number of active participants reported on line 7a of the Form 5500 2020-04-01 132
Number of retired or separated participants receiving benefits 2020-04-01 0
Number of other retired or separated participants entitled to future benefits 2020-04-01 18
Total of all active and inactive participants 2020-04-01 150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-04-01 0
Total participants 2020-04-01 150
Number of participants with account balances 2020-04-01 133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-04-01 0

Measure	Date	Value
2022: JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 2022 401k membership
Total participants, beginning-of-year	2022-04-01	133
Total number of active participants reported on line 7a of the Form 5500	2022-04-01	0
Number of retired or separated participants receiving benefits	2022-04-01	0
Number of other retired or separated participants entitled to future benefits	2022-04-01	0
Total of all active and inactive participants	2022-04-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-04-01	0
Total participants	2022-04-01	0
Number of participants with account balances	2022-04-01	0
2021: JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 2021 401k membership
Total participants, beginning-of-year	2021-04-01	166
Total number of active participants reported on line 7a of the Form 5500	2021-04-01	133
Number of retired or separated participants receiving benefits	2021-04-01	0
Number of other retired or separated participants entitled to future benefits	2021-04-01	13
Total of all active and inactive participants	2021-04-01	146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-04-01	0
Total participants	2021-04-01	146
Number of participants with account balances	2021-04-01	105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-04-01	0
2020: JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 2020 401k membership
Total participants, beginning-of-year	2020-04-01	132
Total number of active participants reported on line 7a of the Form 5500	2020-04-01	132
Number of retired or separated participants receiving benefits	2020-04-01	0
Number of other retired or separated participants entitled to future benefits	2020-04-01	18
Total of all active and inactive participants	2020-04-01	150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-04-01	0
Total participants	2020-04-01	150
Number of participants with account balances	2020-04-01	133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-04-01	0

Financial Data on JOEL M. CORWIN, MD, APC 401(K) P/S PLAN

Measure	Date	Value
2022 : JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 2022 401k financial data
Total income from all sources (including contributions)	2022-05-19	$-447,305
Total of all expenses incurred	2022-05-19	$8,836,070
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-05-19	$8,802,824
Value of total corrective distributions	2022-05-19	$20,099
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-05-19	$0
Value of total assets at end of year	2022-05-19	$0
Value of total assets at beginning of year	2022-05-19	$9,283,375
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-05-19	$13,147
Total interest from all sources	2022-05-19	$86
Total dividends received (eg from common stock, registered investment company shares)	2022-05-19	$66
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-05-19	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2022-05-19	$0
Total dividends received from registered investment company shares (eg mutual funds)	2022-05-19	$66
Was this plan covered by a fidelity bond	2022-05-19	Yes
Value of fidelity bond cover	2022-05-19	$75,000
If this is an individual account plan, was there a blackout period	2022-05-19	No
Were there any nonexempt tranactions with any party-in-interest	2022-05-19	No
Contributions received from participants	2022-05-19	$0
Participant contributions at end of year	2022-05-19	$0
Participant contributions at beginning of year	2022-05-19	$85,897
Participant contributions at end of year	2022-05-19	$0
Participant contributions at beginning of year	2022-05-19	$0
Income. Received or receivable in cash from other sources (including rollovers)	2022-05-19	$0
Total non interest bearing cash at end of year	2022-05-19	$0
Total non interest bearing cash at beginning of year	2022-05-19	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-05-19	No
Value of net income/loss	2022-05-19	$-9,283,375
Value of net assets at end of year (total assets less liabilities)	2022-05-19	$0
Value of net assets at beginning of year (total assets less liabilities)	2022-05-19	$9,283,375
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-05-19	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-05-19	No
Were any leases to which the plan was party in default or uncollectible	2022-05-19	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-05-19	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-05-19	$8,832,578
Value of interest in pooled separate accounts at end of year	2022-05-19	$0
Value of interest in pooled separate accounts at beginning of year	2022-05-19	$364,900
Interest on participant loans	2022-05-19	$86
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-05-19	$-447,457
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-05-19	No
Was there a failure to transmit to the plan any participant contributions	2022-05-19	No
Has the plan failed to provide any benefit when due under the plan	2022-05-19	No
Contributions received in cash from employer	2022-05-19	$0
Employer contributions (assets) at end of year	2022-05-19	$0
Employer contributions (assets) at beginning of year	2022-05-19	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-05-19	$8,802,824
Contract administrator fees	2022-05-19	$13,147
Did the plan have assets held for investment	2022-05-19	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-05-19	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-05-19	Yes
Opinion of an independent qualified public accountant for this plan	2022-05-19	Unqualified
Accountancy firm name	2022-05-19	BAKERTILLY, US, LLP
Accountancy firm EIN	2022-05-19	390859910
Total transfer of assets from this plan	2022-03-31	$25,611
Total income from all sources (including contributions)	2022-03-31	$1,345,781
Total of all expenses incurred	2022-03-31	$7,182,116
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-03-31	$7,037,172
Expenses. Certain deemed distributions of participant loans	2022-03-31	$39,018
Value of total corrective distributions	2022-03-31	$35,688
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-03-31	$693,328
Value of total assets at end of year	2022-03-31	$9,283,375
Value of total assets at beginning of year	2022-03-31	$15,145,321
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-03-31	$70,238
Total interest from all sources	2022-03-31	$9,150
Total dividends received (eg from common stock, registered investment company shares)	2022-03-31	$188,940
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-03-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2022-03-31	$0
Total dividends received from registered investment company shares (eg mutual funds)	2022-03-31	$188,940
Was this plan covered by a fidelity bond	2022-03-31	Yes
Value of fidelity bond cover	2022-03-31	$750,000
If this is an individual account plan, was there a blackout period	2022-03-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-03-31	No
Contributions received from participants	2022-03-31	$595,994
Participant contributions at end of year	2022-03-31	$85,897
Participant contributions at beginning of year	2022-03-31	$147,293
Participant contributions at end of year	2022-03-31	$0
Participant contributions at beginning of year	2022-03-31	$3,813
Income. Received or receivable in cash from other sources (including rollovers)	2022-03-31	$18,244
Total non interest bearing cash at beginning of year	2022-03-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-03-31	No
Value of net income/loss	2022-03-31	$-5,836,335
Value of net assets at end of year (total assets less liabilities)	2022-03-31	$9,283,375
Value of net assets at beginning of year (total assets less liabilities)	2022-03-31	$15,145,321
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-03-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-03-31	No
Were any leases to which the plan was party in default or uncollectible	2022-03-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-03-31	$8,832,578
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-03-31	$14,737,112
Value of interest in pooled separate accounts at end of year	2022-03-31	$364,900
Value of interest in pooled separate accounts at beginning of year	2022-03-31	$256,745
Interest on participant loans	2022-03-31	$9,150
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-03-31	$454,363
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-03-31	No
Was there a failure to transmit to the plan any participant contributions	2022-03-31	No
Has the plan failed to provide any benefit when due under the plan	2022-03-31	No
Contributions received in cash from employer	2022-03-31	$79,090
Employer contributions (assets) at end of year	2022-03-31	$0
Employer contributions (assets) at beginning of year	2022-03-31	$358
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-03-31	$7,037,172
Contract administrator fees	2022-03-31	$70,238
Did the plan have assets held for investment	2022-03-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-03-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-03-31	No
Opinion of an independent qualified public accountant for this plan	2022-03-31	Unqualified
Accountancy firm name	2022-03-31	BAKERTILLY, US, LLP
Accountancy firm EIN	2022-03-31	390859910
2021 : JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 2021 401k financial data
Total transfer of assets to this plan	2021-03-31	$1,515,782
Total transfer of assets from this plan	2021-03-31	$5,560
Total income from all sources (including contributions)	2021-03-31	$4,841,852
Total of all expenses incurred	2021-03-31	$1,895,704
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-03-31	$1,842,485
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-03-31	$605,168
Value of total assets at end of year	2021-03-31	$15,145,321
Value of total assets at beginning of year	2021-03-31	$10,688,951
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-03-31	$53,219
Total interest from all sources	2021-03-31	$8,188
Total dividends received (eg from common stock, registered investment company shares)	2021-03-31	$179,291
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-03-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-03-31	$179,291
Administrative expenses professional fees incurred	2021-03-31	$17,682
Was this plan covered by a fidelity bond	2021-03-31	Yes
Value of fidelity bond cover	2021-03-31	$750,000
If this is an individual account plan, was there a blackout period	2021-03-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-03-31	No
Contributions received from participants	2021-03-31	$504,435
Participant contributions at end of year	2021-03-31	$147,293
Participant contributions at beginning of year	2021-03-31	$168,344
Participant contributions at end of year	2021-03-31	$3,813
Participant contributions at beginning of year	2021-03-31	$3,502
Income. Received or receivable in cash from other sources (including rollovers)	2021-03-31	$40,276
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2021-03-31	$0
Total non interest bearing cash at end of year	2021-03-31	$0
Total non interest bearing cash at beginning of year	2021-03-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-03-31	No
Value of net income/loss	2021-03-31	$2,946,148
Value of net assets at end of year (total assets less liabilities)	2021-03-31	$15,145,321
Value of net assets at beginning of year (total assets less liabilities)	2021-03-31	$10,688,951
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-03-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-03-31	No
Were any leases to which the plan was party in default or uncollectible	2021-03-31	No
Investment advisory and management fees	2021-03-31	$17,682
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-03-31	$14,737,112
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-03-31	$10,284,625
Value of interest in pooled separate accounts at end of year	2021-03-31	$256,745
Value of interest in pooled separate accounts at beginning of year	2021-03-31	$0
Interest on participant loans	2021-03-31	$8,188
Value of interest in common/collective trusts at end of year	2021-03-31	$0
Value of interest in common/collective trusts at beginning of year	2021-03-31	$233,411
Expenses. Payments to insurance carriers foe the provision of benefits	2021-03-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-03-31	$4,048,807
Net investment gain/loss from pooled separate accounts	2021-03-31	$386
Net investment gain or loss from common/collective trusts	2021-03-31	$12
Net gain/loss from 103.12 investment entities	2021-03-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-03-31	No
Was there a failure to transmit to the plan any participant contributions	2021-03-31	No
Has the plan failed to provide any benefit when due under the plan	2021-03-31	No
Contributions received in cash from employer	2021-03-31	$60,457
Employer contributions (assets) at end of year	2021-03-31	$358
Employer contributions (assets) at beginning of year	2021-03-31	$-931
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-03-31	$1,842,485
Contract administrator fees	2021-03-31	$17,855
Did the plan have assets held for investment	2021-03-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-03-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-03-31	No
Opinion of an independent qualified public accountant for this plan	2021-03-31	Unqualified
Accountancy firm name	2021-03-31	BAKERTILLY, US, LLP
Accountancy firm EIN	2021-03-31	390859910

Form 5500 Responses for JOEL M. CORWIN, MD, APC 401(K) P/S PLAN

2022: JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 2022 form 5500 responses
2022-04-01	Type of plan entity	Single employer plan
2022-04-01	Submission has been amended	No
2022-04-01	This submission is the final filing	Yes
2022-04-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-04-01	Plan is a collectively bargained plan	No
2022-04-01	Plan funding arrangement – Insurance	Yes
2022-04-01	Plan funding arrangement – Trust	Yes
2022-04-01	Plan benefit arrangement – Insurance	Yes
2022-04-01	Plan benefit arrangement - Trust	Yes
2021: JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 2021 form 5500 responses
2021-04-01	Type of plan entity	Single employer plan
2021-04-01	Submission has been amended	Yes
2021-04-01	This submission is the final filing	No
2021-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-04-01	Plan is a collectively bargained plan	No
2021-04-01	Plan funding arrangement – Insurance	Yes
2021-04-01	Plan funding arrangement – Trust	Yes
2021-04-01	Plan benefit arrangement – Insurance	Yes
2021-04-01	Plan benefit arrangement - Trust	Yes
2020: JOEL M. CORWIN, MD, APC 401(K) P/S PLAN 2020 form 5500 responses
2020-04-01	Type of plan entity	Single employer plan
2020-04-01	Submission has been amended	No
2020-04-01	This submission is the final filing	No
2020-04-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-04-01	Plan is a collectively bargained plan	No
2020-04-01	Plan funding arrangement – Insurance	Yes
2020-04-01	Plan funding arrangement – Trust	Yes
2020-04-01	Plan benefit arrangement – Insurance	Yes
2020-04-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

528318

Policy instance

Insurance contract or identification number	528318
Number of Individuals Covered	0
Insurance policy start date	2022-04-01
Insurance policy end date	2022-05-19
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $46
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	46
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

528318

Policy instance

Insurance contract or identification number	528318
Number of Individuals Covered	88
Insurance policy start date	2021-04-01
Insurance policy end date	2022-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	133
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

528318

Policy instance

Insurance contract or identification number	528318
Number of Individuals Covered	142
Insurance policy start date	2020-04-01
Insurance policy end date	2021-03-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	128
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

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Company Name:	MIRAMAR EYE SPECIALISTS MEDICAL GROUP, INC.
Employer identification number (EIN):	770019313
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)