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GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan NameGASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST
Plan identification number 001

GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 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
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Plan covering Self-Employed individuals.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. has sponsored the creation of one or more 401k plans.

Company Name:GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L.
Employer identification number (EIN):203383890
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Additional information about GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 2005-08-29
Company Identification Number: L05000085647
Legal Registered Office Address: 1301 RIVERBIRCH LANE

JACKSONVILLE

32207

More information about GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01GAURANG N. SHAH, M.D.
0012013-01-01GAURANG N. SHAH
0012012-01-01GAURANG N. SHAH
0012011-01-01CHARLES A. BROWN
0012009-01-01GAURANG N. SHAH GAURANG N. SHAH2010-10-12

Plan Statistics for GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2017: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-015
Total number of active participants reported on line 7a of the Form 55002017-01-014
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-011
Total of all active and inactive participants2017-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-015
Number of participants with account balances2017-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-015
Total number of active participants reported on line 7a of the Form 55002016-01-014
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-011
Total of all active and inactive participants2016-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-015
Number of participants with account balances2016-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-015
Total number of active participants reported on line 7a of the Form 55002015-01-014
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-011
Total of all active and inactive participants2015-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-015
Number of participants with account balances2015-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-014
Total number of active participants reported on line 7a of the Form 55002014-01-014
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-011
Total of all active and inactive participants2014-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-015
Number of participants with account balances2014-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-014
Total number of active participants reported on line 7a of the Form 55002013-01-013
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-011
Total of all active and inactive participants2013-01-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-014
Number of participants with account balances2013-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-015
Total number of active participants reported on line 7a of the Form 55002012-01-014
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-014
Number of participants with account balances2012-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-013
Total number of active participants reported on line 7a of the Form 55002011-01-012
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-011
Total of all active and inactive participants2011-01-013
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-013
Number of participants with account balances2011-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-013
Total number of active participants reported on line 7a of the Form 55002009-01-013
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-013
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-013
Number of participants with account balances2009-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2017 : GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2017 401k financial data
Total income from all sources2017-12-31$330,621
Expenses. Total of all expenses incurred2017-12-31$13,808
Benefits paid (including direct rollovers)2017-12-31$7,569
Total plan assets at end of year2017-12-31$2,673,968
Total plan assets at beginning of year2017-12-31$2,357,155
Value of fidelity bond covering the plan2017-12-31$230,000
Total contributions received or receivable from participants2017-12-31$50,600
Contributions received from other sources (not participants or employers)2017-12-31$0
Other income received2017-12-31$249,821
Noncash contributions received2017-12-31$0
Net income (gross income less expenses)2017-12-31$316,813
Net plan assets at end of year (total assets less liabilities)2017-12-31$2,673,968
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$2,357,155
Assets. Value of participant loans2017-12-31$6,355
Assets. Value of assets in partnership/joint-venture interests2017-12-31$5,000
Total contributions received or receivable from employer(s)2017-12-31$30,200
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$6,239
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2016 401k financial data
Total income from all sources2016-12-31$189,231
Expenses. Total of all expenses incurred2016-12-31$4,927
Total plan assets at end of year2016-12-31$2,357,155
Total plan assets at beginning of year2016-12-31$2,172,851
Value of fidelity bond covering the plan2016-12-31$230,000
Total contributions received or receivable from participants2016-12-31$50,600
Other income received2016-12-31$88,631
Net income (gross income less expenses)2016-12-31$184,304
Net plan assets at end of year (total assets less liabilities)2016-12-31$2,357,155
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$2,172,851
Assets. Value of assets in partnership/joint-venture interests2016-12-31$13,600
Total contributions received or receivable from employer(s)2016-12-31$50,000
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$4,927
2015 : GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2015 401k financial data
Total income from all sources2015-12-31$-51,234
Expenses. Total of all expenses incurred2015-12-31$160,521
Benefits paid (including direct rollovers)2015-12-31$155,340
Total plan assets at end of year2015-12-31$2,172,851
Total plan assets at beginning of year2015-12-31$2,384,606
Value of fidelity bond covering the plan2015-12-31$90,000
Total contributions received or receivable from participants2015-12-31$50,700
Other income received2015-12-31$-121,934
Net income (gross income less expenses)2015-12-31$-211,755
Net plan assets at end of year (total assets less liabilities)2015-12-31$2,172,851
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$2,384,606
Assets. Value of assets in partnership/joint-venture interests2015-12-31$12,000
Total contributions received or receivable from employer(s)2015-12-31$20,000
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$5,181
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2014 401k financial data
Total income from all sources2014-12-31$301,035
Expenses. Total of all expenses incurred2014-12-31$5,167
Total plan assets at end of year2014-12-31$2,384,606
Total plan assets at beginning of year2014-12-31$2,088,738
Value of fidelity bond covering the plan2014-12-31$90,000
Total contributions received or receivable from participants2014-12-31$48,600
Contributions received from other sources (not participants or employers)2014-12-31$18,027
Other income received2014-12-31$216,408
Net income (gross income less expenses)2014-12-31$295,868
Net plan assets at end of year (total assets less liabilities)2014-12-31$2,384,606
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$2,088,738
Assets. Value of assets in partnership/joint-venture interests2014-12-31$12,000
Total contributions received or receivable from employer(s)2014-12-31$18,000
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$5,167
2013 : GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2013 401k financial data
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$355,848
Expenses. Total of all expenses incurred2013-12-31$8,987
Benefits paid (including direct rollovers)2013-12-31$150,000
Total plan assets at end of year2013-12-31$2,242,174
Total plan assets at beginning of year2013-12-31$1,895,313
Value of fidelity bond covering the plan2013-12-31$90,000
Total contributions received or receivable from participants2013-12-31$48,500
Other income received2013-12-31$267,348
Net income (gross income less expenses)2013-12-31$346,861
Net plan assets at end of year (total assets less liabilities)2013-12-31$2,242,174
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,895,313
Assets. Value of assets in partnership/joint-venture interests2013-12-31$8,000
Total contributions received or receivable from employer(s)2013-12-31$40,000
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$8,987
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$150,000
2012 : GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2012 401k financial data
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$0
Total income from all sources2012-12-31$259,580
Expenses. Total of all expenses incurred2012-12-31$53,950
Benefits paid (including direct rollovers)2012-12-31$38,279
Total plan assets at end of year2012-12-31$1,895,313
Total plan assets at beginning of year2012-12-31$1,689,683
Value of fidelity bond covering the plan2012-12-31$90,000
Total contributions received or receivable from participants2012-12-31$45,000
Other income received2012-12-31$174,580
Net income (gross income less expenses)2012-12-31$205,630
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,895,313
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,689,683
Assets. Value of assets in partnership/joint-venture interests2012-12-31$8,000
Total contributions received or receivable from employer(s)2012-12-31$40,000
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$15,671
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2011 401k financial data
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$-28,514
Expenses. Total of all expenses incurred2011-12-31$16,688
Total plan assets at end of year2011-12-31$1,689,683
Total plan assets at beginning of year2011-12-31$1,734,885
Value of fidelity bond covering the plan2011-12-31$90,000
Total contributions received or receivable from participants2011-12-31$44,000
Other income received2011-12-31$-115,345
Net income (gross income less expenses)2011-12-31$-45,202
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,689,683
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,734,885
Assets. Value of assets in partnership/joint-venture interests2011-12-31$8,000
Total contributions received or receivable from employer(s)2011-12-31$42,831
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$16,688
2010 : GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$328,103
Expenses. Total of all expenses incurred2010-12-31$14,747
Total plan assets at end of year2010-12-31$1,734,885
Total plan assets at beginning of year2010-12-31$1,421,529
Value of fidelity bond covering the plan2010-12-31$90,000
Total contributions received or receivable from participants2010-12-31$8,239
Expenses. Other expenses not covered elsewhere2010-12-31$9
Other income received2010-12-31$288,103
Net income (gross income less expenses)2010-12-31$313,356
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,734,885
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,421,529
Assets. Value of assets in partnership/joint-venture interests2010-12-31$25,000
Total contributions received or receivable from employer(s)2010-12-31$31,761
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$14,738

Form 5500 Responses for GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST

2017: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 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: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 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: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 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: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
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: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 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: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 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
2009: GASTROENTEROLOGY ASSOCIATES OF NORTHEAST FLORIDA, P.L. 401(K) PROFIT SHARING PLAN AND TRUST 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE0899806
Policy instance 1
Insurance contract or identification numberE0899806
Number of Individuals Covered1
Insurance policy start date2016-11-15
Insurance policy end date2017-11-14
Total amount of commissions paid to insurance brokerUSD $4,500
Total amount of fees paid to insurance companyUSD $0
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 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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,500
Insurance broker organization code?3
Insurance broker nameKEVIN D MAHER
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE0899806
Policy instance 1
Insurance contract or identification numberE0899806
Number of Individuals Covered1
Insurance policy start date2014-11-15
Insurance policy end date2015-11-14
Total amount of commissions paid to insurance brokerUSD $4,488
Total amount of fees paid to insurance companyUSD $0
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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,488
Insurance broker organization code?3
Insurance broker nameKEVIN D MAHER
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE0899806
Policy instance 1
Insurance contract or identification numberE0899806
Number of Individuals Covered1
Insurance policy start date2013-11-15
Insurance policy end date2014-11-14
Total amount of commissions paid to insurance brokerUSD $4,195
Total amount of fees paid to insurance companyUSD $0
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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,195
Insurance broker organization code?3
Insurance broker nameKEVIN D MAHER
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE0899806
Policy instance 1
Insurance contract or identification numberE0899806
Number of Individuals Covered1
Insurance policy start date2012-11-15
Insurance policy end date2013-11-14
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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE0899806
Policy instance 1
Insurance contract or identification numberE0899806
Number of Individuals Covered1
Insurance policy start date2011-11-15
Insurance policy end date2012-11-14
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?No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE0899806
Policy instance 1
Insurance contract or identification numberE0899806
Number of Individuals Covered1
Insurance policy start date2010-11-15
Insurance policy end date2011-11-14
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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?No
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
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberTRN44800540
Policy instance 1
Insurance contract or identification numberTRN44800540
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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?No
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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE0899806
Policy instance 2
Insurance contract or identification numberE0899806
Number of Individuals Covered1
Insurance policy start date2009-11-15
Insurance policy end date2010-11-14
Total amount of commissions paid to insurance brokerUSD $14,894
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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?No
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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