401k Plan data: HASKELL VET CLINIC 401(K) PLAN plan

HASKELL VET CLINIC 401(K) PLAN 401k Plan overview

Plan Name	HASKELL VET CLINIC 401(K) PLAN
Plan identification number	001

HASKELL VET CLINIC 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
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

HASKELL VETERINARY CLINIC has sponsored the creation of one or more 401k plans.

Company Name: HASKELL VETERINARY CLINIC

Employer identification number (EIN): 270178409

NAIC Classification: 541940
NAIC Description: Veterinary Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HASKELL VET CLINIC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 RENEE GOBER 2023-05-25
001 2021-01-01 RENEE GOBER 2022-07-04
001 2020-01-01 RENEE GOBER 2021-04-14
001 2019-01-01 RENEE GOBER 2020-05-14
001 2018-01-01 RENEE GOBER 2019-05-03
001 2017-01-01 RENEE GOBER 2018-06-07
001 2016-01-01 RENEE GOBER 2017-05-11
001 2015-01-01
001 2014-01-01 RENEE GOBER
001 2013-01-01 RENEE GOBER
001 2012-01-01 RENEE GOBER
001 2011-01-01 RENEE GOBER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	RENEE GOBER	2023-05-25
001	2021-01-01	RENEE GOBER	2022-07-04
001	2020-01-01	RENEE GOBER	2021-04-14
001	2019-01-01	RENEE GOBER	2020-05-14
001	2018-01-01	RENEE GOBER	2019-05-03
001	2017-01-01	RENEE GOBER	2018-06-07
001	2016-01-01	RENEE GOBER	2017-05-11
001	2015-01-01
001	2014-01-01	RENEE GOBER
001	2013-01-01	RENEE GOBER
001	2012-01-01	RENEE GOBER
001	2011-01-01	RENEE GOBER

Plan Statistics for HASKELL VET CLINIC 401(K) PLAN

401k plan membership statisitcs for HASKELL VET CLINIC 401(K) PLAN

Measure Date Value
2014: HASKELL VET CLINIC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 5
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 6
Number of participants with account balances 2014-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: HASKELL VET CLINIC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 6
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 1
Total of all active and inactive participants 2013-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 7
Number of participants with account balances 2013-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: HASKELL VET CLINIC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 6
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 1
Total of all active and inactive participants 2012-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 7
Number of participants with account balances 2012-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: HASKELL VET CLINIC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 1
Total of all active and inactive participants 2011-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 5
Number of participants with account balances 2011-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2014: HASKELL VET CLINIC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	5
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	6
Number of participants with account balances	2014-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: HASKELL VET CLINIC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	6
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	1
Total of all active and inactive participants	2013-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	7
Number of participants with account balances	2013-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: HASKELL VET CLINIC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	6
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	1
Total of all active and inactive participants	2012-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	7
Number of participants with account balances	2012-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: HASKELL VET CLINIC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	1
Total of all active and inactive participants	2011-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	5
Number of participants with account balances	2011-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on HASKELL VET CLINIC 401(K) PLAN

Measure	Date	Value
2014 : HASKELL VET CLINIC 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$45,933
Expenses. Total of all expenses incurred	2014-12-31	$240
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$223,091
Total plan assets at beginning of year	2014-12-31	$177,398
Value of fidelity bond covering the plan	2014-12-31	$200,000
Total contributions received or receivable from participants	2014-12-31	$37,966
Expenses. Other expenses not covered elsewhere	2014-12-31	$240
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$648
Net income (gross income less expenses)	2014-12-31	$45,693
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$223,091
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$177,398
Assets. Value of participant loans	2014-12-31	$0
Total contributions received or receivable from employer(s)	2014-12-31	$7,319
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
2013 : HASKELL VET CLINIC 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$70,792
Expenses. Total of all expenses incurred	2013-12-31	$240
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$177,398
Total plan assets at beginning of year	2013-12-31	$106,846
Value of fidelity bond covering the plan	2013-12-31	$200,000
Total contributions received or receivable from participants	2013-12-31	$37,547
Expenses. Other expenses not covered elsewhere	2013-12-31	$240
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$25,896
Net income (gross income less expenses)	2013-12-31	$70,552
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$177,398
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$106,846
Assets. Value of participant loans	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$7,349
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
2012 : HASKELL VET CLINIC 401(K) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$48,726
Expenses. Total of all expenses incurred	2012-12-31	$210
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$106,846
Total plan assets at beginning of year	2012-12-31	$58,330
Value of fidelity bond covering the plan	2012-12-31	$100,000
Total contributions received or receivable from participants	2012-12-31	$34,364
Expenses. Other expenses not covered elsewhere	2012-12-31	$210
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$8,534
Net income (gross income less expenses)	2012-12-31	$48,516
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$106,846
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$58,330
Assets. Value of participant loans	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$5,828
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
2011 : HASKELL VET CLINIC 401(K) PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$29,170
Expenses. Total of all expenses incurred	2011-12-31	$180
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$58,330
Total plan assets at beginning of year	2011-12-31	$29,340
Value of fidelity bond covering the plan	2011-12-31	$100,000
Total contributions received or receivable from participants	2011-12-31	$29,824
Expenses. Other expenses not covered elsewhere	2011-12-31	$180
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-3,884
Net income (gross income less expenses)	2011-12-31	$28,990
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$58,330
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$29,340
Assets. Value of participant loans	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$3,230
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
2010 : HASKELL VET CLINIC 401(K) PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$325
Total income from all sources	2010-12-31	$29,127
Expenses. Total of all expenses incurred	2010-12-31	$112
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$29,340
Total plan assets at beginning of year	2010-12-31	$0
Value of fidelity bond covering the plan	2010-12-31	$25,000
Total contributions received or receivable from participants	2010-12-31	$22,174
Expenses. Other expenses not covered elsewhere	2010-12-31	$112
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$2,913
Net income (gross income less expenses)	2010-12-31	$29,015
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$29,340
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$0
Assets. Value of participant loans	2010-12-31	$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2010-12-31	$60
Total contributions received or receivable from employer(s)	2010-12-31	$4,040
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0

Form 5500 Responses for HASKELL VET CLINIC 401(K) PLAN

2014: HASKELL VET CLINIC 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: HASKELL VET CLINIC 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: HASKELL VET CLINIC 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: HASKELL VET CLINIC 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-821521

Policy instance

Insurance contract or identification number	GA-821521
Number of Individuals Covered	6
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $756
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $756
Insurance broker organization code?	3
Insurance broker name	EDWARD D JONES & CO L P.

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-821521

Policy instance

Insurance contract or identification number	GA-821521
Number of Individuals Covered	7
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $494
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $494
Insurance broker organization code?	3
Insurance broker name	EDWARD D JONES & CO

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-821521

Policy instance

Insurance contract or identification number	GA-821521
Number of Individuals Covered	6
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $279
Total amount of fees paid to insurance company	USD $70
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $279
Insurance broker organization code?	3
Amount paid for insurance broker fees	70
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker name	EDWARD D JONES & CO

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-821521

Policy instance

Insurance contract or identification number	GA-821521
Number of Individuals Covered	5
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $143
Total amount of fees paid to insurance company	USD $36
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-821521

Policy instance

Insurance contract or identification number	GA-821521
Number of Individuals Covered	5
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $20
Total amount of fees paid to insurance company	USD $5
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20
Insurance broker organization code?	3
Amount paid for insurance broker fees	5
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker name	EDWARD D JONES & CO

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Company Name:	HASKELL VETERINARY CLINIC
Employer identification number (EIN):	270178409
NAIC Classification:	541940
NAIC Description:	Veterinary Services