401k Plan data: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN plan

ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN
Plan identification number	001

ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC.

Employer identification number (EIN): 330861642

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 LISA JEWELL 2019-07-29
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01 MICHAEL NEWMAN

Plan Statistics for ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2018: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 15
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 5
Total of all active and inactive participants 2018-01-01 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 20
Number of participants with account balances 2018-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 3
2017: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 13
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 5
Total of all active and inactive participants 2017-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 18
Number of participants with account balances 2017-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 1
2016: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 10
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 5
Total of all active and inactive participants 2016-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 15
Number of participants with account balances 2016-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 11
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 3
Total of all active and inactive participants 2015-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 14
Number of participants with account balances 2015-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 12
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 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 13
Number of participants with account balances 2014-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1

Measure	Date	Value
2018: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	15
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	5
Total of all active and inactive participants	2018-01-01	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	20
Number of participants with account balances	2018-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	3
2017: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	13
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	5
Total of all active and inactive participants	2017-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	18
Number of participants with account balances	2017-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	1
2016: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	10
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	5
Total of all active and inactive participants	2016-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	15
Number of participants with account balances	2016-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	11
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	3
Total of all active and inactive participants	2015-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	14
Number of participants with account balances	2015-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	12
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	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	13
Number of participants with account balances	2014-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1

Financial Data on ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2018 : ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$0
Total income from all sources	2018-12-31	$172,135
Expenses. Total of all expenses incurred	2018-12-31	$272,731
Benefits paid (including direct rollovers)	2018-12-31	$267,975
Total plan assets at end of year	2018-12-31	$802,645
Total plan assets at beginning of year	2018-12-31	$903,241
Value of fidelity bond covering the plan	2018-12-31	$75,000
Total contributions received or receivable from participants	2018-12-31	$93,484
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$12,184
Other income received	2018-12-31	$-46,037
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$-100,596
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$802,645
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$903,241
Assets. Value of participant loans	2018-12-31	$3,909
Total contributions received or receivable from employer(s)	2018-12-31	$112,504
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$4,756
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING 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	$296,895
Expenses. Total of all expenses incurred	2017-12-31	$11,444
Benefits paid (including direct rollovers)	2017-12-31	$6,846
Total plan assets at end of year	2017-12-31	$903,241
Total plan assets at beginning of year	2017-12-31	$617,790
Value of fidelity bond covering the plan	2017-12-31	$50,000
Total contributions received or receivable from participants	2017-12-31	$86,776
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$100,501
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$285,451
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$903,241
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$617,790
Total contributions received or receivable from employer(s)	2017-12-31	$109,618
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$4,598
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$268,786
Expenses. Total of all expenses incurred	2016-12-31	$16,285
Benefits paid (including direct rollovers)	2016-12-31	$12,390
Total plan assets at end of year	2016-12-31	$617,790
Total plan assets at beginning of year	2016-12-31	$365,289
Value of fidelity bond covering the plan	2016-12-31	$50,000
Total contributions received or receivable from participants	2016-12-31	$89,507
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$34,498
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$252,501
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$617,790
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$365,289
Total contributions received or receivable from employer(s)	2016-12-31	$144,781
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$3,895
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$192,437
Expenses. Total of all expenses incurred	2015-12-31	$3,555
Benefits paid (including direct rollovers)	2015-12-31	$1,829
Total plan assets at end of year	2015-12-31	$365,289
Total plan assets at beginning of year	2015-12-31	$176,407
Value of fidelity bond covering the plan	2015-12-31	$35,000
Total contributions received or receivable from participants	2015-12-31	$57,133
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-8,915
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$188,882
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$365,289
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$176,407
Assets. Value of participant loans	2015-12-31	$1,126
Total contributions received or receivable from employer(s)	2015-12-31	$144,219
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$1,726
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total income from all sources	2014-12-31	$176,407
Expenses. Total of all expenses incurred	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$176,407
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$0
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$176,407
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$176,407
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$0
Total contributions received or receivable from employer(s)	2014-12-31	$176,407
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$0

Form 5500 Responses for ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN

2018: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING 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 – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING 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 – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING 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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC. 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
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 – Trust	Yes
2014-01-01	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

805977-000

Policy instance

Insurance contract or identification number	805977-000
Number of Individuals Covered	20
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,740
Total amount of fees paid to insurance company	USD $370
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 $1,272
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3

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

Policy contract number

805977-000

Policy instance

Insurance contract or identification number	805977-000
Number of Individuals Covered	18
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,266
Total amount of fees paid to insurance company	USD $332
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 $1,110
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	WINDES, INC.

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

Policy contract number

805977-000

Policy instance

Insurance contract or identification number	805977-000
Number of Individuals Covered	14
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $668
Total amount of fees paid to insurance company	USD $375
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 $0
Amount paid for insurance broker fees	375
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	5
Insurance broker name	OPPENHEIMER LIFE AGENCY LTD

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Company Name:	ASSOC. OF SOUTH BAY PLASTIC SURGEONS MEDICAL GROUP, INC.
Employer identification number (EIN):	330861642
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01	LISA JEWELL	2019-07-29
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01	MICHAEL NEWMAN