401k Plan data: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY plan

MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 401k Plan overview

Plan Name	MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY
Plan identification number	506

MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

MAINE CENTER FOR CANCER MEDICINE & BLOOD DISORDERS, P.A. D/B/A has sponsored the creation of one or more 401k plans.

Company Name: MAINE CENTER FOR CANCER MEDICINE & BLOOD DISORDERS, P.A. D/B/A

Employer identification number (EIN): 010357684

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
506 2017-01-01 ISABELLA BOUFFARD ISABELLA BOUFFARD 2018-05-03
506 2017-01-01 TAMI HAMILTON 2022-01-13
506 2016-01-01 ISABELLA BOUFFARD ISABELLA BOUFFARD 2017-05-15
506 2015-01-01 ISABELLA BOUFFARD ISABELLA BOUFFARD 2016-05-07
506 2014-01-01 ISABELLA BOUFFARD
506 2013-01-01 ISABELLA BOUFFARD ISABELLA BOUFFARD 2014-05-10
506 2012-01-01 ISABELLA BOUFFARD ISABELLA BOUFFARD 2013-04-23
506 2011-11-01 ISABELLA BOUFFARD
506 2009-11-01 ISABELLA BOUFFARD
506 2008-11-01 ISABELLA BOUFFARD

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
506	2017-01-01	ISABELLA BOUFFARD		ISABELLA BOUFFARD	2018-05-03
506	2017-01-01	TAMI HAMILTON	2022-01-13
506	2016-01-01	ISABELLA BOUFFARD		ISABELLA BOUFFARD	2017-05-15
506	2015-01-01	ISABELLA BOUFFARD		ISABELLA BOUFFARD	2016-05-07
506	2014-01-01	ISABELLA BOUFFARD
506	2013-01-01	ISABELLA BOUFFARD		ISABELLA BOUFFARD	2014-05-10
506	2012-01-01	ISABELLA BOUFFARD		ISABELLA BOUFFARD	2013-04-23
506	2011-11-01	ISABELLA BOUFFARD
506	2009-11-01	ISABELLA BOUFFARD
506	2008-11-01	ISABELLA BOUFFARD

Plan Statistics for MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY

401k plan membership statisitcs for MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY

Measure Date Value
2017: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2017 401k membership
Total participants, beginning-of-year 2017-01-01 157
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 164
Total of all active and inactive participants 2017-01-01 164
Total participants 2017-01-01 164
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Number of employers contributing to the scheme 2017-01-01 0
2016: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2016 401k membership
Total participants, beginning-of-year 2016-01-01 144
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 157
Total of all active and inactive participants 2016-01-01 157
Total participants 2016-01-01 157
2015: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2015 401k membership
Total participants, beginning-of-year 2015-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 144
Total of all active and inactive participants 2015-01-01 144
Total participants 2015-01-01 144
2014: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2014 401k membership
Total participants, beginning-of-year 2014-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 134
Total of all active and inactive participants 2014-01-01 134
Total participants 2014-01-01 134
2013: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2013 401k membership
Total participants, beginning-of-year 2013-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 133
Total of all active and inactive participants 2013-01-01 133
Total participants 2013-01-01 133
2012: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2012 401k membership
Total participants, beginning-of-year 2012-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 128
Total of all active and inactive participants 2012-01-01 128
Total participants 2012-01-01 128
2011: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2011 401k membership
Total participants, beginning-of-year 2011-11-01 110
Total number of active participants reported on line 7a of the Form 5500 2011-11-01 111
Total of all active and inactive participants 2011-11-01 111
Total participants 2011-11-01 111
2009: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2009 401k membership
Total participants, beginning-of-year 2009-11-01 125
Total number of active participants reported on line 7a of the Form 5500 2009-11-01 116
Total of all active and inactive participants 2009-11-01 116
Total participants 2009-11-01 116
2008: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2008 401k membership
Total participants, beginning-of-year 2008-11-01 125
Total number of active participants reported on line 7a of the Form 5500 2008-11-01 120
Total of all active and inactive participants 2008-11-01 120
Total participants 2008-11-01 120

Measure	Date	Value
2017: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2017 401k membership
Total participants, beginning-of-year	2017-01-01	157
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	164
Total of all active and inactive participants	2017-01-01	164
Total participants	2017-01-01	164
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Number of employers contributing to the scheme	2017-01-01	0
2016: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2016 401k membership
Total participants, beginning-of-year	2016-01-01	144
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	157
Total of all active and inactive participants	2016-01-01	157
Total participants	2016-01-01	157
2015: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2015 401k membership
Total participants, beginning-of-year	2015-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	144
Total of all active and inactive participants	2015-01-01	144
Total participants	2015-01-01	144
2014: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2014 401k membership
Total participants, beginning-of-year	2014-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	134
Total of all active and inactive participants	2014-01-01	134
Total participants	2014-01-01	134
2013: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2013 401k membership
Total participants, beginning-of-year	2013-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	133
Total of all active and inactive participants	2013-01-01	133
Total participants	2013-01-01	133
2012: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2012 401k membership
Total participants, beginning-of-year	2012-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	128
Total of all active and inactive participants	2012-01-01	128
Total participants	2012-01-01	128
2011: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2011 401k membership
Total participants, beginning-of-year	2011-11-01	110
Total number of active participants reported on line 7a of the Form 5500	2011-11-01	111
Total of all active and inactive participants	2011-11-01	111
Total participants	2011-11-01	111
2009: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2009 401k membership
Total participants, beginning-of-year	2009-11-01	125
Total number of active participants reported on line 7a of the Form 5500	2009-11-01	116
Total of all active and inactive participants	2009-11-01	116
Total participants	2009-11-01	116
2008: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2008 401k membership
Total participants, beginning-of-year	2008-11-01	125
Total number of active participants reported on line 7a of the Form 5500	2008-11-01	120
Total of all active and inactive participants	2008-11-01	120
Total participants	2008-11-01	120

Form 5500 Responses for MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY

2017: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 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 benefit arrangement – Insurance	Yes
2015: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2015 form 5500 responses
2015-01-01	Type of plan entity	Single 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 benefit arrangement – Insurance	Yes
2014: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2014 form 5500 responses
2014-01-01	Type of plan entity	Single 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 benefit arrangement – Insurance	Yes
2013: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2013 form 5500 responses
2013-01-01	Type of plan entity	Single 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 benefit arrangement – Insurance	Yes
2012: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2011 form 5500 responses
2011-11-01	Type of plan entity	Single employer plan
2011-11-01	Submission has been amended	No
2011-11-01	This submission is the final filing	No
2011-11-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2011-11-01	Plan is a collectively bargained plan	No
2011-11-01	Plan funding arrangement – Insurance	Yes
2011-11-01	Plan benefit arrangement – Insurance	Yes
2009: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2009 form 5500 responses
2009-11-01	Type of plan entity	Single employer plan
2009-11-01	Submission has been amended	No
2009-11-01	This submission is the final filing	No
2009-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-11-01	Plan is a collectively bargained plan	No
2009-11-01	Plan funding arrangement – Insurance	Yes
2009-11-01	Plan benefit arrangement – Insurance	Yes
2008: MAINE CENTER FOR CANCER MEDICINE AND BLOOD DISORDERS PA LIFE AND DISABLITY 2008 form 5500 responses
2008-11-01	Type of plan entity	Single employer plan
2008-11-01	First time form 5500 has been submitted	Yes
2008-11-01	Submission has been amended	No
2008-11-01	This submission is the final filing	No
2008-11-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-11-01	Plan is a collectively bargained plan	No
2008-11-01	Plan funding arrangement – Insurance	Yes
2008-11-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

676349G

Policy instance

Insurance contract or identification number	676349G
Number of Individuals Covered	164
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $28,942
Total amount of fees paid to insurance company	USD $2,420
Are there contracts with allocated funds for individual policies?	0
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $267,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $28,936
Insurance broker organization code?	3
Amount paid for insurance broker fees	2426
Insurance broker name	USI INS SERVICES LLC

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Company Name:	MAINE CENTER FOR CANCER MEDICINE & BLOOD DISORDERS, P.A. D/B/A
Employer identification number (EIN):	010357684
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)