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VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 401k Plan overview

Plan NameVALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN
Plan identification number 001

VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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.

401k Sponsoring company profile

VALLEY PEDIATRICS, P.C. has sponsored the creation of one or more 401k plans.

Company Name:VALLEY PEDIATRICS, P.C.
Employer identification number (EIN):233023090
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01RONALD ENDO2023-05-14 RONALD ENDO2023-05-14
0012021-01-01RONALD NOBORU ENDO2022-04-25 RONALD NOBORU ENDO2022-04-25
0012020-01-01RONALD NOBORU ENDO2021-07-11 RONALD NOBORU ENDO2021-07-11
0012019-01-01RONALD N. ENDO2020-07-30 RONALD N. ENDO2020-07-30
0012018-01-01RONALD N ENDO, M.D.2019-05-23 RONALD N ENDO, M.D.2019-05-23
0012017-01-01BARBARA ENDO2018-06-20 BARBARA ENDO2018-06-20
0012016-01-01
0012015-01-01IAN HARING2016-08-12
0012014-01-01IAN HARING2015-08-13
0012013-01-01IAN HARING IAN HARING2014-11-17
0012012-01-01IAN HARING IAN HARING2014-11-17
0012011-01-01IAN HARING IAN HARING2014-11-17
0012009-01-01IAN HARING IAN HARING2014-11-17
0012009-01-01IAN HARING IAN HARING2010-09-07

Plan Statistics for VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN

401k plan membership statisitcs for VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN

Measure Date Value
2013: VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0150
Total number of active participants reported on line 7a of the Form 55002013-01-0124
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0120
Total of all active and inactive participants2013-01-0144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-011
Total participants2013-01-0145
Number of participants with account balances2013-01-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0148
Total number of active participants reported on line 7a of the Form 55002012-01-0130
Number of retired or separated participants receiving benefits2012-01-011
Number of other retired or separated participants entitled to future benefits2012-01-0117
Total of all active and inactive participants2012-01-0148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-011
Total participants2012-01-0149
Number of participants with account balances2012-01-0149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0149
Total number of active participants reported on line 7a of the Form 55002011-01-0128
Number of retired or separated participants receiving benefits2011-01-011
Number of other retired or separated participants entitled to future benefits2011-01-0118
Total of all active and inactive participants2011-01-0147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-011
Total participants2011-01-0148
Number of participants with account balances2011-01-0148
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0156
Total number of active participants reported on line 7a of the Form 55002009-01-0128
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0123
Total of all active and inactive participants2009-01-0151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0151
Number of participants with account balances2009-01-0151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN

Measure Date Value
2013 : VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$307,877
Expenses. Total of all expenses incurred2013-12-31$139,982
Benefits paid (including direct rollovers)2013-12-31$139,582
Total plan assets at end of year2013-12-31$3,672,470
Total plan assets at beginning of year2013-12-31$3,504,575
Value of fidelity bond covering the plan2013-12-31$400,000
Assets. Value of tangible personal property2013-12-31$187,902
Total contributions received or receivable from participants2013-12-31$64,858
Expenses. Other expenses not covered elsewhere2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$202,783
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$167,895
Net plan assets at end of year (total assets less liabilities)2013-12-31$3,672,470
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$3,504,575
Total contributions received or receivable from employer(s)2013-12-31$40,236
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$400
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$114
Total income from all sources2012-12-31$319,021
Expenses. Total of all expenses incurred2012-12-31$103,354
Benefits paid (including direct rollovers)2012-12-31$103,304
Total plan assets at end of year2012-12-31$3,504,575
Total plan assets at beginning of year2012-12-31$3,289,022
Value of fidelity bond covering the plan2012-12-31$400,000
Assets. Value of tangible personal property2012-12-31$258,570
Total contributions received or receivable from participants2012-12-31$64,938
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$212,985
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$215,667
Net plan assets at end of year (total assets less liabilities)2012-12-31$3,504,575
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$3,288,908
Total contributions received or receivable from employer(s)2012-12-31$41,098
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$50
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total plan liabilities at end of year2011-12-31$114
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$277,489
Expenses. Total of all expenses incurred2011-12-31$262,194
Benefits paid (including direct rollovers)2011-12-31$261,480
Total plan assets at end of year2011-12-31$3,289,022
Total plan assets at beginning of year2011-12-31$3,273,613
Value of fidelity bond covering the plan2011-12-31$400,000
Assets. Value of tangible personal property2011-12-31$244,421
Total contributions received or receivable from participants2011-12-31$58,032
Expenses. Other expenses not covered elsewhere2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$52,062
Other income received2011-12-31$130,485
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$15,295
Net plan assets at end of year (total assets less liabilities)2011-12-31$3,288,908
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$3,273,613
Total contributions received or receivable from employer(s)2011-12-31$36,910
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$714
2010 : VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 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$318,172
Expenses. Total of all expenses incurred2010-12-31$175,698
Benefits paid (including direct rollovers)2010-12-31$175,674
Total plan assets at end of year2010-12-31$3,273,613
Total plan assets at beginning of year2010-12-31$3,131,139
Value of fidelity bond covering the plan2010-12-31$400,000
Assets. Value of tangible personal property2010-12-31$156,000
Total contributions received or receivable from participants2010-12-31$61,737
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$218,493
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$142,474
Net plan assets at end of year (total assets less liabilities)2010-12-31$3,273,613
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$3,131,139
Total contributions received or receivable from employer(s)2010-12-31$37,942
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$24
2009 : VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 2009 401k financial data
Transfers to/from the plan2009-12-31$0
Total plan liabilities at end of year2009-12-31$0
Total plan liabilities at beginning of year2009-12-31$173
Total income from all sources2009-12-31$252,191
Expenses. Total of all expenses incurred2009-12-31$158,750
Benefits paid (including direct rollovers)2009-12-31$158,522
Total plan assets at end of year2009-12-31$2,975,139
Total plan assets at beginning of year2009-12-31$2,881,871
Value of fidelity bond covering the plan2009-12-31$400,000
Total contributions received or receivable from participants2009-12-31$67,386
Expenses. Other expenses not covered elsewhere2009-12-31$0
Contributions received from other sources (not participants or employers)2009-12-31$0
Other income received2009-12-31$141,602
Noncash contributions received2009-12-31$0
Net income (gross income less expenses)2009-12-31$93,441
Net plan assets at end of year (total assets less liabilities)2009-12-31$2,975,139
Net plan assets at beginning of year (total assets less liabilities)2009-12-31$2,881,698
Total contributions received or receivable from employer(s)2009-12-31$43,203
Value of certain deemed distributions of participant loans2009-12-31$0
Value of corrective distributions2009-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2009-12-31$228
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN

2013: VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 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: VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedYes
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: VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
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: VALLEY PEDIATRICS, P.C. 401K PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
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

MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number61381
Policy instance 1
Insurance contract or identification number61381
Number of Individuals Covered45
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $13,301
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?Yes
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
Other information about contractGROUP VARIABLE ANNUITY
Commission paid to Insurance BrokerUSD $13,301
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL CORPORATION
UNITED INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 65765 )
Policy contract number4051358
Policy instance 2
Insurance contract or identification number4051358
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number61381
Policy instance 1
Insurance contract or identification number61381
Number of Individuals Covered48
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $12,520
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?Yes
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
Other information about contractGROUP VARIABLE ANNUITY
Commission paid to Insurance BrokerUSD $6,260
Insurance broker organization code?3
Insurance broker nameTHOMAS H VICKERS III LINSCO PRIVATE
UNITED INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 65765 )
Policy contract number4051358
Policy instance 2
Insurance contract or identification number4051358
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number61381
Policy instance 1
Insurance contract or identification number61381
Number of Individuals Covered48
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $12,092
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?Yes
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
Other information about contractGROUP VARIABLE ANNUITY
UNITED INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 65765 )
Policy contract number4051358
Policy instance 2
Insurance contract or identification number4051358
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number61381
Policy instance 1
Insurance contract or identification number61381
Number of Individuals Covered47
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $11,934
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?Yes
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
Other information about contractGROUP VARIABLE ANNUITY
UNITED INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 65765 )
Policy contract number4051358
Policy instance 2
Insurance contract or identification number4051358
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MINNESOTA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66168 )
Policy contract number61381
Policy instance 1
Insurance contract or identification number61381
Number of Individuals Covered51
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $11,096
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?Yes
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
Other information about contractGROUP VARIABLE ANNUITY
Commission paid to Insurance BrokerUSD $5,548
Insurance broker organization code?3
Insurance broker nameTHOMAS VICKERS III - LINSCO PRIVATE
UNITED INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 65765 )
Policy contract number4051358
Policy instance 2
Insurance contract or identification number4051358
Number of Individuals Covered1
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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