401k Plan data: PACIFIC EYE INSTITUTE 401(K) PLAN plan

PACIFIC EYE INSTITUTE 401(K) PLAN 401k Plan overview

Plan Name	PACIFIC EYE INSTITUTE 401(K) PLAN
Plan identification number	001

PACIFIC EYE INSTITUTE 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

PACIFIC EYE INSTITUTE has sponsored the creation of one or more 401k plans.

Company Name: PACIFIC EYE INSTITUTE

Employer identification number (EIN): 330303507

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC EYE INSTITUTE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01 KATIE SWENGROS 2021-06-30
001 2019-01-01 KATIE SWENGROS 2021-06-30
001 2018-01-01 KATIE SWENGROS 2018-06-30
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01 ROBERT FABRICANT
001 2013-01-01 RAY SHOJINAGA
001 2012-01-01 ROBERT FABRICANT MD ROBERT FABRICANT MD 2014-02-13
001 2011-01-01 ROBERT FABRICANT MD ROBERT FABRICANT MD 2012-03-26
001 2009-01-01 ROBERT FABRICANT MD ROBERT FABRICANT MD 2010-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2019-01-01	KATIE SWENGROS	2021-06-30
001	2019-01-01	KATIE SWENGROS	2021-06-30
001	2018-01-01	KATIE SWENGROS	2018-06-30
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01	ROBERT FABRICANT
001	2013-01-01	RAY SHOJINAGA
001	2012-01-01	ROBERT FABRICANT MD		ROBERT FABRICANT MD	2014-02-13
001	2011-01-01	ROBERT FABRICANT MD		ROBERT FABRICANT MD	2012-03-26
001	2009-01-01	ROBERT FABRICANT MD		ROBERT FABRICANT MD	2010-10-13

Plan Statistics for PACIFIC EYE INSTITUTE 401(K) PLAN

401k plan membership statisitcs for PACIFIC EYE INSTITUTE 401(K) PLAN

Measure Date Value
2019: PACIFIC EYE INSTITUTE 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 149
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 0
Number of participants with account balances 2019-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 6
2018: PACIFIC EYE INSTITUTE 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 135
Number of retired or separated participants receiving benefits 2018-01-01 1
Number of other retired or separated participants entitled to future benefits 2018-01-01 8
Total of all active and inactive participants 2018-01-01 144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 144
Number of participants with account balances 2018-01-01 46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 5
2017: PACIFIC EYE INSTITUTE 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 131
Number of retired or separated participants receiving benefits 2017-01-01 1
Number of other retired or separated participants entitled to future benefits 2017-01-01 6
Total of all active and inactive participants 2017-01-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 138
Number of participants with account balances 2017-01-01 51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 2
2016: PACIFIC EYE INSTITUTE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 98
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 109
Number of retired or separated participants receiving benefits 2016-01-01 2
Number of other retired or separated participants entitled to future benefits 2016-01-01 6
Total of all active and inactive participants 2016-01-01 117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 117
Number of participants with account balances 2016-01-01 41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 2
2015: PACIFIC EYE INSTITUTE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 98
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 88
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 8
Total of all active and inactive participants 2015-01-01 96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 96
Number of participants with account balances 2015-01-01 39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: PACIFIC EYE INSTITUTE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 91
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 86
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 12
Total of all active and inactive participants 2014-01-01 98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 98
Number of participants with account balances 2014-01-01 46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1
2013: PACIFIC EYE INSTITUTE 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 81
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 82
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 9
Total of all active and inactive participants 2013-01-01 91
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 91
Number of participants with account balances 2013-01-01 46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: PACIFIC EYE INSTITUTE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 80
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 75
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 6
Total of all active and inactive participants 2012-01-01 81
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 81
Number of participants with account balances 2012-01-01 43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: PACIFIC EYE INSTITUTE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 75
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 74
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 6
Total of all active and inactive participants 2011-01-01 80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 80
Number of participants with account balances 2011-01-01 44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 2
2009: PACIFIC EYE INSTITUTE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 70
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 79
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 7
Total of all active and inactive participants 2009-01-01 86
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 86
Number of participants with account balances 2009-01-01 48
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2019: PACIFIC EYE INSTITUTE 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	0
Number of participants with account balances	2019-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	6
2018: PACIFIC EYE INSTITUTE 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	135
Number of retired or separated participants receiving benefits	2018-01-01	1
Number of other retired or separated participants entitled to future benefits	2018-01-01	8
Total of all active and inactive participants	2018-01-01	144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	144
Number of participants with account balances	2018-01-01	46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	5
2017: PACIFIC EYE INSTITUTE 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	131
Number of retired or separated participants receiving benefits	2017-01-01	1
Number of other retired or separated participants entitled to future benefits	2017-01-01	6
Total of all active and inactive participants	2017-01-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	138
Number of participants with account balances	2017-01-01	51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	2
2016: PACIFIC EYE INSTITUTE 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	98
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	109
Number of retired or separated participants receiving benefits	2016-01-01	2
Number of other retired or separated participants entitled to future benefits	2016-01-01	6
Total of all active and inactive participants	2016-01-01	117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	117
Number of participants with account balances	2016-01-01	41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2
2015: PACIFIC EYE INSTITUTE 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	98
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	88
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	8
Total of all active and inactive participants	2015-01-01	96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	96
Number of participants with account balances	2015-01-01	39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: PACIFIC EYE INSTITUTE 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	91
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	86
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	12
Total of all active and inactive participants	2014-01-01	98
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	98
Number of participants with account balances	2014-01-01	46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1
2013: PACIFIC EYE INSTITUTE 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	81
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	82
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	9
Total of all active and inactive participants	2013-01-01	91
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	91
Number of participants with account balances	2013-01-01	46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: PACIFIC EYE INSTITUTE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	80
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	75
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	6
Total of all active and inactive participants	2012-01-01	81
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	81
Number of participants with account balances	2012-01-01	43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: PACIFIC EYE INSTITUTE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	75
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	74
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	6
Total of all active and inactive participants	2011-01-01	80
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	80
Number of participants with account balances	2011-01-01	44
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	2
2009: PACIFIC EYE INSTITUTE 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	70
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	79
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	7
Total of all active and inactive participants	2009-01-01	86
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	86
Number of participants with account balances	2009-01-01	48
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on PACIFIC EYE INSTITUTE 401(K) PLAN

Measure	Date	Value
2019 : PACIFIC EYE INSTITUTE 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total transfer of assets from this plan	2019-12-31	$3,719,116
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$84,583
Total income from all sources (including contributions)	2019-12-31	$973,912
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$1,496,896
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,485,039
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$320,621
Value of total assets at end of year	2019-12-31	$0
Value of total assets at beginning of year	2019-12-31	$4,326,683
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$11,857
Total interest from all sources	2019-12-31	$14,653
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2019-12-31	$0
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$205,372
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$74,691
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$3,211
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$84,583
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Income. Non cash contributions	2019-12-31	$0
Value of net income/loss	2019-12-31	$-522,984
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$0
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,242,100
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in pooled separate accounts at end of year	2019-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$4,122,360
Interest on participant loans	2019-12-31	$3,883
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$45,049
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$45,049
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$10,770
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$0
Net investment gain/loss from pooled separate accounts	2019-12-31	$638,638
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$115,249
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$81,372
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,485,039
Contract administrator fees	2019-12-31	$11,857
Did the plan have assets held for investment	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	SILICON VALLEY ACCOUNTANCY CORP
Accountancy firm EIN	2019-12-31	770573994
2018 : PACIFIC EYE INSTITUTE 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total transfer of assets from this plan	2018-12-31	$50,704
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$50,704
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$81,911
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$324,971
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$306,513
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$321,121
Value of total assets at end of year	2018-12-31	$4,292,804
Value of total assets at beginning of year	2018-12-31	$4,535,864
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$18,458
Total interest from all sources	2018-12-31	$14,835
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$0
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$189,456
Participant contributions at end of year	2018-12-31	$74,691
Participant contributions at beginning of year	2018-12-31	$89,945
Participant contributions at end of year	2018-12-31	$3,024
Participant contributions at beginning of year	2018-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$11,324
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2018-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$50,704
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$0
Administrative expenses (other) incurred	2018-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Income. Non cash contributions	2018-12-31	$0
Value of net income/loss	2018-12-31	$-243,060
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$4,242,100
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$4,535,864
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$18,458
Value of interest in pooled separate accounts at end of year	2018-12-31	$4,119,630
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$3,534,971
Interest on participant loans	2018-12-31	$3,580
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$47,779
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$11,255
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$910,948
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$0
Net investment gain/loss from pooled separate accounts	2018-12-31	$-254,045
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$120,341
Employer contributions (assets) at end of year	2018-12-31	$47,680
Employer contributions (assets) at beginning of year	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$306,513
Contract administrator fees	2018-12-31	$0
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	SILICON VALLEY ACCOUNTANCY CORP
Accountancy firm EIN	2018-12-31	770573994
2017 : PACIFIC EYE INSTITUTE 401(K) PLAN 2017 401k financial data
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$984,949
Expenses. Total of all expenses incurred	2017-12-31	$320,999
Benefits paid (including direct rollovers)	2017-12-31	$199,366
Total plan assets at end of year	2017-12-31	$4,535,864
Total plan assets at beginning of year	2017-12-31	$3,871,914
Value of fidelity bond covering the plan	2017-12-31	$300,000
Total contributions received or receivable from participants	2017-12-31	$198,149
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$231,175
Other income received	2017-12-31	$474,509
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$663,950
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$4,535,864
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$3,871,914
Assets. Value of participant loans	2017-12-31	$89,945
Total contributions received or receivable from employer(s)	2017-12-31	$81,116
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$102,790
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$18,843
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : PACIFIC EYE INSTITUTE 401(K) PLAN 2016 401k financial data
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$503,894
Expenses. Total of all expenses incurred	2016-12-31	$227,419
Benefits paid (including direct rollovers)	2016-12-31	$150,130
Total plan assets at end of year	2016-12-31	$3,871,914
Total plan assets at beginning of year	2016-12-31	$3,595,439
Value of fidelity bond covering the plan	2016-12-31	$300,000
Total contributions received or receivable from participants	2016-12-31	$195,462
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$6,147
Other income received	2016-12-31	$229,847
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$276,475
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$3,871,914
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$3,595,439
Assets. Value of participant loans	2016-12-31	$35,237
Total contributions received or receivable from employer(s)	2016-12-31	$72,438
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$60,300
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$16,989
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : PACIFIC EYE INSTITUTE 401(K) PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total income from all sources	2015-12-31	$246,190
Expenses. Total of all expenses incurred	2015-12-31	$133,816
Benefits paid (including direct rollovers)	2015-12-31	$102,305
Total plan assets at end of year	2015-12-31	$3,595,439
Total plan assets at beginning of year	2015-12-31	$3,483,065
Value of fidelity bond covering the plan	2015-12-31	$300,000
Total contributions received or receivable from participants	2015-12-31	$184,549
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-1,907
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$112,374
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$3,595,439
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$3,483,065
Assets. Value of participant loans	2015-12-31	$40,597
Total contributions received or receivable from employer(s)	2015-12-31	$63,548
Value of corrective distributions	2015-12-31	$15,046
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$16,465
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : PACIFIC EYE INSTITUTE 401(K) PLAN 2014 401k financial data
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$406,842
Expenses. Total of all expenses incurred	2014-12-31	$109,721
Benefits paid (including direct rollovers)	2014-12-31	$53,452
Total plan assets at end of year	2014-12-31	$3,483,065
Total plan assets at beginning of year	2014-12-31	$3,185,944
Value of fidelity bond covering the plan	2014-12-31	$300,000
Total contributions received or receivable from participants	2014-12-31	$183,330
Other income received	2014-12-31	$154,864
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$297,121
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$3,483,065
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$3,185,944
Assets. Value of participant loans	2014-12-31	$44,716
Total contributions received or receivable from employer(s)	2014-12-31	$68,648
Value of certain deemed distributions of participant loans	2014-12-31	$17,167
Value of corrective distributions	2014-12-31	$39,102
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : PACIFIC EYE INSTITUTE 401(K) PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$575,481
Expenses. Total of all expenses incurred	2013-12-31	$31,664
Benefits paid (including direct rollovers)	2013-12-31	$18,503
Total plan assets at end of year	2013-12-31	$3,185,944
Total plan assets at beginning of year	2013-12-31	$2,642,127
Value of fidelity bond covering the plan	2013-12-31	$300,000
Total contributions received or receivable from participants	2013-12-31	$144,772
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$366,161
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$543,817
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$3,185,944
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,642,127
Assets. Value of participant loans	2013-12-31	$70,844
Total contributions received or receivable from employer(s)	2013-12-31	$64,548
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$13,161
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : PACIFIC EYE INSTITUTE 401(K) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$401,861
Expenses. Total of all expenses incurred	2012-12-31	$46,623
Benefits paid (including direct rollovers)	2012-12-31	$35,461
Total plan assets at end of year	2012-12-31	$2,643,072
Total plan assets at beginning of year	2012-12-31	$2,287,834
Value of fidelity bond covering the plan	2012-12-31	$300,000
Total contributions received or receivable from participants	2012-12-31	$140,470
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$205,253
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$355,238
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,643,072
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,287,834
Assets. Value of participant loans	2012-12-31	$87,132
Total contributions received or receivable from employer(s)	2012-12-31	$56,138
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$11,162
2011 : PACIFIC EYE INSTITUTE 401(K) PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$194,622
Expenses. Total of all expenses incurred	2011-12-31	$80,260
Benefits paid (including direct rollovers)	2011-12-31	$79,756
Total plan assets at end of year	2011-12-31	$2,287,834
Total plan assets at beginning of year	2011-12-31	$2,173,472
Value of fidelity bond covering the plan	2011-12-31	$300,000
Total contributions received or receivable from participants	2011-12-31	$147,718
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-8,348
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$114,362
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,287,834
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,173,472
Assets. Value of participant loans	2011-12-31	$71,208
Total contributions received or receivable from employer(s)	2011-12-31	$55,252
Value of certain deemed distributions of participant loans	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$504
2010 : PACIFIC EYE INSTITUTE 401(K) PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$409,648
Expenses. Total of all expenses incurred	2010-12-31	$128,454
Benefits paid (including direct rollovers)	2010-12-31	$127,171
Total plan assets at end of year	2010-12-31	$2,173,472
Total plan assets at beginning of year	2010-12-31	$1,892,278
Value of fidelity bond covering the plan	2010-12-31	$300,000
Total contributions received or receivable from participants	2010-12-31	$162,907
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$1,857
Other income received	2010-12-31	$180,178
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$281,194
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,173,472
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,892,278
Assets. Value of participant loans	2010-12-31	$65,525
Total contributions received or receivable from employer(s)	2010-12-31	$64,706
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$1,283

Form 5500 Responses for PACIFIC EYE INSTITUTE 401(K) PLAN

2019: PACIFIC EYE INSTITUTE 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	Yes
2019-01-01	This submission is the final filing	Yes
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: PACIFIC EYE INSTITUTE 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: PACIFIC EYE INSTITUTE 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: PACIFIC EYE INSTITUTE 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: PACIFIC EYE INSTITUTE 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: PACIFIC EYE INSTITUTE 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
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: PACIFIC EYE INSTITUTE 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
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PACIFIC EYE INSTITUTE 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	Yes
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
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PACIFIC EYE INSTITUTE 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
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: PACIFIC EYE INSTITUTE 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

800902-000

Policy instance

Insurance contract or identification number	800902-000
Number of Individuals Covered	0
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $1,919
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	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 $0
Amount paid for insurance broker fees	1919
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	5

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

800902-000

Policy instance

Insurance contract or identification number	800902-000
Number of Individuals Covered	46
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $8,930
Total amount of fees paid to insurance company	USD $1,695
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	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 $4,488
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

800902-000

Policy instance

Insurance contract or identification number	800902-000
Number of Individuals Covered	135
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $16,511
Total amount of fees paid to insurance company	USD $2,071
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	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 $12,615
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Amount paid for insurance broker fees	1746
Insurance broker name	FLYNN, SHOJINAGA & ASSOCIATES, INC.

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Company Name:	PACIFIC EYE INSTITUTE
Employer identification number (EIN):	330303507
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)