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EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 401k Plan overview

Plan NameEDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN
Plan identification number 001

EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN Benefits

401k Plan TypeDefined Benefit Pension
Plan Features/Benefits
  • Benefits are primarily pay related
  • Cash balance or similar plan - Plan has a "cash balance" formula. For this purpose, a "cash balance" formula is a benefit formula in a defined benefit plan by whatever name (for example, personal account plan, pension equity plan, life cycle plan, cash account plan, etc.) that rather than, or in addition to, expressing the accrued benefit as a life annuity commencing at normal retirement age, defines benefits for each employee in terms more common to a defined contribution plan such as a single sum distribution amount (for example, 10 percent of final average pay times years of service, or the amount of the employee's hypothetical account balance).
  • 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

EDWIN K. CHAN, MD., PC. has sponsored the creation of one or more 401k plans.

Company Name:EDWIN K. CHAN, MD., PC.
Employer identification number (EIN):262428393
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01EDWIN CHAN2023-09-21
0012021-01-01EDWIN CHAN2022-09-15
0012020-01-01EDWIN CHAN2021-08-18
0012019-01-01EDWIN CHAN2020-09-16
0012018-01-01EDWIN CHAN2019-09-11
0012015-01-01EDWIN CHAN2016-10-03
0012014-01-01EDWIN CHAN
0012013-01-01EDWIN CHAN
0012012-01-01EDWIN CHAN
0012011-01-01EDWIN K. CHAN2012-06-21

Plan Statistics for EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN

401k plan membership statisitcs for EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN

Measure Date Value
2022: EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2022 401k membership
Market value of plan assets2022-12-312,172,874
Acturial value of plan assets2022-12-312,172,874
Funding target for retired participants and beneficiaries receiving payment2022-12-310
Number of terminated vested participants2022-12-311
Fundng target for terminated vested participants2022-12-311,712
Active participant vested funding target2022-12-311,751,072
Number of active participants2022-12-315
Total funding liabilities for active participants2022-12-311,751,072
Total participant count2022-12-316
Total funding target for all participants2022-12-311,752,784
Balance at beginning of prior year after applicable adjustments2022-12-310
Prefunding balance at beginning of prior year after applicable adjustments2022-12-31102,710
Carryover balanced portion elected for use to offset prior years funding requirement2022-12-310
Prefunding balanced used to offset prior years funding requirement2022-12-310
Amount remaining of carryover balance2022-12-310
Amount remaining of prefunding balance2022-12-31102,710
Present value of excess contributions2022-12-31190,928
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance2022-12-31201,181
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance2022-12-31201,181
Reductions in caryover balances due to elections or deemed elections2022-12-310
Reductions in prefunding balances due to elections or deemed elections2022-12-310
Balance of carryovers at beginning of current year2022-12-310
Balance of prefunding at beginning of current year2022-12-31319,410
Total employer contributions2022-12-31400,000
Total employee contributions2022-12-310
Contributions allocated toward unpaid minimum require contributions from prior years2022-12-310
Contributions made to avoid restrictions adjusted to valuation date2022-12-310
Contributions allocated toward minimum required contributions for current year adjusted to valuation date2022-12-31369,049
Unpaid minimum required contributions for all prior years2022-12-310
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years2022-12-310
Remaining amount of unpaid minimum required contributions2022-12-310
Minimum required contributions for current year target normal cost2022-12-31157,018
Net shortfall amortization installment of oustanding balance2022-12-310
Waiver amortization installment2022-12-310
Total funding amount beforereflecting carryover/prefunding balances2022-12-3156,338
Carryover balance elected to use to offset funding requirement2022-12-310
Prefunding balance elected to use to offset funding requirement2022-12-310
Additional cash requirement2022-12-3156,338
Contributions allocatedtoward minimum required contributions for current year2022-12-31369,049
Unpaid minimum required contributions for current year2022-12-310
Unpaid minimum required contributions for all years2022-12-310
2021: EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2021 401k membership
Market value of plan assets2021-12-311,636,730
Acturial value of plan assets2021-12-311,636,730
Funding target for retired participants and beneficiaries receiving payment2021-12-310
Number of terminated vested participants2021-12-310
Fundng target for terminated vested participants2021-12-310
Active participant vested funding target2021-12-311,473,747
Number of active participants2021-12-316
Total funding liabilities for active participants2021-12-311,473,747
Total participant count2021-12-316
Total funding target for all participants2021-12-311,473,747
Balance at beginning of prior year after applicable adjustments2021-12-310
Prefunding balance at beginning of prior year after applicable adjustments2021-12-31163,951
Carryover balanced portion elected for use to offset prior years funding requirement2021-12-310
Prefunding balanced used to offset prior years funding requirement2021-12-3173,720
Amount remaining of carryover balance2021-12-310
Amount remaining of prefunding balance2021-12-3190,231
Present value of excess contributions2021-12-310
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance2021-12-310
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance2021-12-310
Reductions in caryover balances due to elections or deemed elections2021-12-310
Reductions in prefunding balances due to elections or deemed elections2021-12-310
Balance of carryovers at beginning of current year2021-12-310
Balance of prefunding at beginning of current year2021-12-31102,710
Total employer contributions2021-12-31305,000
Total employee contributions2021-12-310
Contributions allocated toward unpaid minimum require contributions from prior years2021-12-310
Contributions made to avoid restrictions adjusted to valuation date2021-12-310
Contributions allocated toward minimum required contributions for current year adjusted to valuation date2021-12-31275,927
Unpaid minimum required contributions for all prior years2021-12-310
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years2021-12-310
Remaining amount of unpaid minimum required contributions2021-12-310
Minimum required contributions for current year target normal cost2021-12-31145,272
Net shortfall amortization installment of oustanding balance2021-12-310
Waiver amortization installment2021-12-310
Total funding amount beforereflecting carryover/prefunding balances2021-12-3184,999
Carryover balance elected to use to offset funding requirement2021-12-310
Prefunding balance elected to use to offset funding requirement2021-12-310
Additional cash requirement2021-12-3184,999
Contributions allocatedtoward minimum required contributions for current year2021-12-31275,927
Unpaid minimum required contributions for current year2021-12-310
Unpaid minimum required contributions for all years2021-12-310
2020: EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2020 401k membership
Market value of plan assets2020-12-311,342,955
Acturial value of plan assets2020-12-311,342,955
Funding target for retired participants and beneficiaries receiving payment2020-12-310
Number of terminated vested participants2020-12-310
Fundng target for terminated vested participants2020-12-310
Active participant vested funding target2020-12-311,288,847
Number of active participants2020-12-316
Total funding liabilities for active participants2020-12-311,288,847
Total participant count2020-12-316
Total funding target for all participants2020-12-311,288,847
Balance at beginning of prior year after applicable adjustments2020-12-310
Prefunding balance at beginning of prior year after applicable adjustments2020-12-31196,671
Carryover balanced portion elected for use to offset prior years funding requirement2020-12-310
Prefunding balanced used to offset prior years funding requirement2020-12-3154,068
Amount remaining of carryover balance2020-12-310
Amount remaining of prefunding balance2020-12-31142,603
Present value of excess contributions2020-12-310
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance2020-12-310
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance2020-12-310
Reductions in caryover balances due to elections or deemed elections2020-12-310
Reductions in prefunding balances due to elections or deemed elections2020-12-310
Balance of carryovers at beginning of current year2020-12-310
Balance of prefunding at beginning of current year2020-12-31163,951
Total employer contributions2020-12-31103,871
Total employee contributions2020-12-310
Contributions allocated toward unpaid minimum require contributions from prior years2020-12-310
Contributions made to avoid restrictions adjusted to valuation date2020-12-310
Contributions allocated toward minimum required contributions for current year adjusted to valuation date2020-12-3193,672
Unpaid minimum required contributions for all prior years2020-12-310
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years2020-12-310
Remaining amount of unpaid minimum required contributions2020-12-310
Minimum required contributions for current year target normal cost2020-12-31146,083
Net shortfall amortization installment of oustanding balance2020-12-31109,843
Waiver amortization installment2020-12-310
Total funding amount beforereflecting carryover/prefunding balances2020-12-31166,030
Carryover balance elected to use to offset funding requirement2020-12-310
Prefunding balance elected to use to offset funding requirement2020-12-3172,358
Additional cash requirement2020-12-3193,672
Contributions allocatedtoward minimum required contributions for current year2020-12-3193,672
Unpaid minimum required contributions for current year2020-12-310
Unpaid minimum required contributions for all years2020-12-310
2019: EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2019 401k membership
Market value of plan assets2019-12-311,083,824
Acturial value of plan assets2019-12-311,083,824
Funding target for retired participants and beneficiaries receiving payment2019-12-310
Number of terminated vested participants2019-12-310
Fundng target for terminated vested participants2019-12-310
Active participant vested funding target2019-12-31998,265
Number of active participants2019-12-316
Total funding liabilities for active participants2019-12-31998,265
Total participant count2019-12-316
Total funding target for all participants2019-12-31998,265
Balance at beginning of prior year after applicable adjustments2019-12-310
Prefunding balance at beginning of prior year after applicable adjustments2019-12-31182,189
Carryover balanced portion elected for use to offset prior years funding requirement2019-12-310
Prefunding balanced used to offset prior years funding requirement2019-12-310
Amount remaining of carryover balance2019-12-310
Amount remaining of prefunding balance2019-12-31182,189
Present value of excess contributions2019-12-3118,057
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance2019-12-3119,110
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance2019-12-3119,110
Reductions in caryover balances due to elections or deemed elections2019-12-310
Reductions in prefunding balances due to elections or deemed elections2019-12-310
Balance of carryovers at beginning of current year2019-12-310
Balance of prefunding at beginning of current year2019-12-31196,671
Total employer contributions2019-12-31104,123
Total employee contributions2019-12-310
Contributions allocated toward unpaid minimum require contributions from prior years2019-12-310
Contributions made to avoid restrictions adjusted to valuation date2019-12-310
Contributions allocated toward minimum required contributions for current year adjusted to valuation date2019-12-3195,504
Unpaid minimum required contributions for all prior years2019-12-310
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years2019-12-310
Remaining amount of unpaid minimum required contributions2019-12-310
Minimum required contributions for current year target normal cost2019-12-31131,518
Net shortfall amortization installment of oustanding balance2019-12-31111,112
Waiver amortization installment2019-12-310
Total funding amount beforereflecting carryover/prefunding balances2019-12-31149,572
Carryover balance elected to use to offset funding requirement2019-12-310
Prefunding balance elected to use to offset funding requirement2019-12-3154,068
Additional cash requirement2019-12-3195,504
Contributions allocatedtoward minimum required contributions for current year2019-12-3195,504
Unpaid minimum required contributions for current year2019-12-310
Unpaid minimum required contributions for all years2019-12-310
2018: EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2018 401k membership
Market value of plan assets2018-12-311,002,264
Acturial value of plan assets2018-12-311,002,264
Funding target for retired participants and beneficiaries receiving payment2018-12-310
Number of terminated vested participants2018-12-310
Fundng target for terminated vested participants2018-12-310
Active participant vested funding target2018-12-31791,167
Number of active participants2018-12-316
Total funding liabilities for active participants2018-12-31791,167
Total participant count2018-12-316
Total funding target for all participants2018-12-31791,167
Balance at beginning of prior year after applicable adjustments2018-12-310
Prefunding balance at beginning of prior year after applicable adjustments2018-12-31163,795
Carryover balanced portion elected for use to offset prior years funding requirement2018-12-310
Prefunding balanced used to offset prior years funding requirement2018-12-310
Amount remaining of carryover balance2018-12-310
Amount remaining of prefunding balance2018-12-31163,795
Present value of excess contributions2018-12-310
Total available prior years excess cotributions available at beginning of current plan year to add to prefunding balance2018-12-310
Total available prior years excess cotributions added at beginning of current plan year to add to prefunding balance2018-12-310
Reductions in caryover balances due to elections or deemed elections2018-12-310
Reductions in prefunding balances due to elections or deemed elections2018-12-310
Balance of carryovers at beginning of current year2018-12-310
Balance of prefunding at beginning of current year2018-12-31182,189
Total employer contributions2018-12-31109,684
Total employee contributions2018-12-310
Contributions allocated toward unpaid minimum require contributions from prior years2018-12-310
Contributions made to avoid restrictions adjusted to valuation date2018-12-310
Contributions allocated toward minimum required contributions for current year adjusted to valuation date2018-12-31101,160
Unpaid minimum required contributions for all prior years2018-12-310
iDiscounted employer contributions allocated toward unpaid minimum required contributions from prior years2018-12-310
Remaining amount of unpaid minimum required contributions2018-12-310
Minimum required contributions for current year target normal cost2018-12-31112,011
Net shortfall amortization installment of oustanding balance2018-12-310
Waiver amortization installment2018-12-310
Total funding amount beforereflecting carryover/prefunding balances2018-12-3183,103
Carryover balance elected to use to offset funding requirement2018-12-310
Prefunding balance elected to use to offset funding requirement2018-12-310
Additional cash requirement2018-12-3183,103
Contributions allocatedtoward minimum required contributions for current year2018-12-31101,160
Unpaid minimum required contributions for current year2018-12-310
Unpaid minimum required contributions for all years2018-12-310
2014: EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-014
Total number of active participants reported on line 7a of the Form 55002014-01-012
Number of retired or separated participants receiving benefits2014-01-012
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-014
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-014
Total number of active participants reported on line 7a of the Form 55002013-01-012
Number of retired or separated participants receiving benefits2013-01-012
Number of other retired or separated participants entitled to future benefits2013-01-010
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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-014
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
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010

Financial Data on EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN

Measure Date Value
2014 : EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$411,510
Expenses. Total of all expenses incurred2014-12-31$130,845
Benefits paid (including direct rollovers)2014-12-31$120,000
Total plan assets at end of year2014-12-31$1,624,053
Total plan assets at beginning of year2014-12-31$1,343,388
Total contributions received or receivable from participants2014-12-31$0
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$169,684
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$280,665
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,624,053
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,343,388
Total contributions received or receivable from employer(s)2014-12-31$241,826
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$10,845
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
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$415,425
Expenses. Total of all expenses incurred2013-12-31$164,022
Benefits paid (including direct rollovers)2013-12-31$151,255
Total plan assets at end of year2013-12-31$1,343,388
Total plan assets at beginning of year2013-12-31$1,091,985
Total contributions received or receivable from participants2013-12-31$0
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$75,521
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$251,403
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,343,388
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,091,985
Total contributions received or receivable from employer(s)2013-12-31$339,904
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$12,767
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
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$284,468
Expenses. Total of all expenses incurred2012-12-31$123,353
Benefits paid (including direct rollovers)2012-12-31$119,255
Total plan assets at end of year2012-12-31$1,091,985
Total plan assets at beginning of year2012-12-31$930,870
Total contributions received or receivable from participants2012-12-31$0
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$-22,594
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$161,115
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,091,985
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$930,870
Total contributions received or receivable from employer(s)2012-12-31$307,062
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$4,098
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0

Form 5500 Responses for EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN

2014: EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
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: EDWIN K. CHAN, MD., PC. DEFINED BENEFIT PLAN 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

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number157227143
Policy instance 1
Insurance contract or identification number157227143
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,313
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $31,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,313
Insurance broker organization code?3
Insurance broker nameJASON C FU
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number157227143
Policy instance 1
Insurance contract or identification number157227143
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,313
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $31,255
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,313
Insurance broker organization code?3
Insurance broker nameJASON C FU

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