401k Plan data: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN plan

UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN
Plan identification number	002

UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS 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.
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

UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. has sponsored the creation of one or more 401k plans.

Company Name: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C.

Employer identification number (EIN): 840611813

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2016-01-01 RACHEL COCHRAN
002 2015-01-01 JULIE BURKE
002 2015-01-01 JULIE BURKE
002 2014-01-01 KARLA MOSEY
002 2014-01-01 KARLA MOSEY
002 2013-01-01 JOHN SKILLICORN
002 2012-01-01 JOHN SKILLICORN 2013-04-03
002 2011-01-01 JOHN SKILLICORN 2012-04-04
002 2010-01-01 JOHN SKILLICORN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2016-01-01	RACHEL COCHRAN
002	2015-01-01	JULIE BURKE
002	2015-01-01	JULIE BURKE
002	2014-01-01	KARLA MOSEY
002	2014-01-01	KARLA MOSEY
002	2013-01-01	JOHN SKILLICORN
002	2012-01-01	JOHN SKILLICORN	2013-04-03
002	2011-01-01	JOHN SKILLICORN	2012-04-04
002	2010-01-01	JOHN SKILLICORN

Plan Statistics for UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN

Measure Date Value
2016: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 30
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 12
Total of all active and inactive participants 2016-01-01 42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 42
Number of participants with account balances 2016-01-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 34
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 4
Total of all active and inactive participants 2015-01-01 38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 38
Number of participants with account balances 2015-01-01 38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 32
Number of retired or separated participants receiving benefits 2014-01-01 5
Number of other retired or separated participants entitled to future benefits 2014-01-01 4
Total of all active and inactive participants 2014-01-01 41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 41
Number of participants with account balances 2014-01-01 41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 32
Number of retired or separated participants receiving benefits 2013-01-01 3
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 37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 37
Number of participants with account balances 2013-01-01 37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2010: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 31
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 34
Number of retired or separated participants receiving benefits 2010-01-01 2
Number of other retired or separated participants entitled to future benefits 2010-01-01 3
Total of all active and inactive participants 2010-01-01 39
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 39
Number of participants with account balances 2010-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0

Measure	Date	Value
2016: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	30
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	12
Total of all active and inactive participants	2016-01-01	42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	42
Number of participants with account balances	2016-01-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	34
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	4
Total of all active and inactive participants	2015-01-01	38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	38
Number of participants with account balances	2015-01-01	38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	32
Number of retired or separated participants receiving benefits	2014-01-01	5
Number of other retired or separated participants entitled to future benefits	2014-01-01	4
Total of all active and inactive participants	2014-01-01	41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	41
Number of participants with account balances	2014-01-01	41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	32
Number of retired or separated participants receiving benefits	2013-01-01	3
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	37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	37
Number of participants with account balances	2013-01-01	37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2010: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	34
Number of retired or separated participants receiving benefits	2010-01-01	2
Number of other retired or separated participants entitled to future benefits	2010-01-01	3
Total of all active and inactive participants	2010-01-01	39
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	39
Number of participants with account balances	2010-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0

Financial Data on UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN

Measure	Date	Value
2016 : UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$936,942
Expenses. Total of all expenses incurred	2016-12-31	$67,899
Benefits paid (including direct rollovers)	2016-12-31	$67,493
Total plan assets at end of year	2016-12-31	$5,890,648
Total plan assets at beginning of year	2016-12-31	$5,021,605
Value of fidelity bond covering the plan	2016-12-31	$100,000
Total contributions received or receivable from participants	2016-12-31	$179,419
Other income received	2016-12-31	$499,543
Net income (gross income less expenses)	2016-12-31	$869,043
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$5,890,648
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$5,021,605
Assets. Value of participant loans	2016-12-31	$33,555
Total contributions received or receivable from employer(s)	2016-12-31	$257,980
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$406
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total income from all sources	2015-12-31	$306,625
Expenses. Total of all expenses incurred	2015-12-31	$237,540
Benefits paid (including direct rollovers)	2015-12-31	$237,348
Total plan assets at end of year	2015-12-31	$5,019,897
Total plan assets at beginning of year	2015-12-31	$4,950,812
Value of fidelity bond covering the plan	2015-12-31	$400,000
Total contributions received or receivable from participants	2015-12-31	$174,588
Other income received	2015-12-31	$-144,192
Net income (gross income less expenses)	2015-12-31	$69,085
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$5,019,897
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$4,950,812
Assets. Value of participant loans	2015-12-31	$15,402
Total contributions received or receivable from employer(s)	2015-12-31	$276,229
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$192
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2014 401k financial data
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$688,703
Expenses. Total of all expenses incurred	2014-12-31	$453,806
Benefits paid (including direct rollovers)	2014-12-31	$453,182
Total plan assets at end of year	2014-12-31	$4,950,812
Total plan assets at beginning of year	2014-12-31	$4,715,915
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$174,806
Contributions received from other sources (not participants or employers)	2014-12-31	$20,850
Other income received	2014-12-31	$225,015
Net income (gross income less expenses)	2014-12-31	$234,897
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$4,950,812
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$4,715,915
Assets. Value of participant loans	2014-12-31	$21,823
Total contributions received or receivable from employer(s)	2014-12-31	$268,032
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$624
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$1,075,080
Expenses. Total of all expenses incurred	2013-12-31	$90,443
Benefits paid (including direct rollovers)	2013-12-31	$90,147
Total plan assets at end of year	2013-12-31	$4,715,915
Total plan assets at beginning of year	2013-12-31	$3,731,278
Total contributions received or receivable from participants	2013-12-31	$173,857
Contributions received from other sources (not participants or employers)	2013-12-31	$29,544
Other income received	2013-12-31	$604,120
Net income (gross income less expenses)	2013-12-31	$984,637
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$4,715,915
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$3,731,278
Assets. Value of participant loans	2013-12-31	$15,483
Total contributions received or receivable from employer(s)	2013-12-31	$267,559
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$296
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2010 : UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$632,137
Expenses. Total of all expenses incurred	2010-12-31	$36,443
Benefits paid (including direct rollovers)	2010-12-31	$36,443
Total plan assets at end of year	2010-12-31	$2,697,756
Total plan assets at beginning of year	2010-12-31	$2,102,062
Total contributions received or receivable from participants	2010-12-31	$116,064
Contributions received from other sources (not participants or employers)	2010-12-31	$2,367
Other income received	2010-12-31	$260,923
Net income (gross income less expenses)	2010-12-31	$595,694
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,697,756
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,102,062
Total contributions received or receivable from employer(s)	2010-12-31	$252,783
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN

2016: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Mulitple employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Mulitple employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Mulitple employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2010: UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C. RETIREMENT SAVINGS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

91220

Policy instance

Insurance contract or identification number	91220
Number of Individuals Covered	32
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $24,754
Total amount of fees paid to insurance company	USD $3,345
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 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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,754
Insurance broker organization code?	3
Amount paid for insurance broker fees	3345
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	HUNTER BENEFITS CONSULTING GROUP

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

91220

Policy instance

Insurance contract or identification number	91220
Number of Individuals Covered	37
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $26,646
Total amount of fees paid to insurance company	USD $500
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 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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $24,206
Insurance broker organization code?	3
Amount paid for insurance broker fees	500
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	HUNTER BENEFITS CONSULTING GROUP

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

91220

Policy instance

Insurance contract or identification number	91220
Number of Individuals Covered	36
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $20,038
Total amount of fees paid to insurance company	USD $2,205
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 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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,038
Insurance broker organization code?	3
Amount paid for insurance broker fees	2205
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	HUNTER BENEFITS CONSULTING GROUP

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

91220

Policy instance

Insurance contract or identification number	91220
Number of Individuals Covered	34
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $10,897
Total amount of fees paid to insurance company	USD $4,585
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 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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	UROLOGICAL ASSOCIATES OF WESTERN COLORADO, P.C.
Employer identification number (EIN):	840611813
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)