401k Plan data: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN plan

PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 401k Plan overview

Plan Name	PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN
Plan identification number	001

PETER BOTTAR DO INC EMPLOYEES 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
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.
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

PETER BOTTAR DO INC. has sponsored the creation of one or more 401k plans.

Company Name: PETER BOTTAR DO INC.

Employer identification number (EIN): 341315037

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-06-01
001 2016-06-01
001 2015-06-01
001 2014-06-01
001 2013-06-01
001 2012-06-01 PETER BOTTAR
001 2011-06-01 PETER BOTTAR
001 2009-06-01 PETER BOTTAR

Plan Statistics for PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN

401k plan membership statisitcs for PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN

Measure Date Value
2017: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-06-01 4
Total number of active participants reported on line 7a of the Form 5500 2017-06-01 0
Number of retired or separated participants receiving benefits 2017-06-01 0
Number of other retired or separated participants entitled to future benefits 2017-06-01 0
Total of all active and inactive participants 2017-06-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-06-01 0
Total participants 2017-06-01 0
Number of participants with account balances 2017-06-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-06-01 0
2016: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-06-01 4
Total number of active participants reported on line 7a of the Form 5500 2016-06-01 4
Number of retired or separated participants receiving benefits 2016-06-01 0
Number of other retired or separated participants entitled to future benefits 2016-06-01 0
Total of all active and inactive participants 2016-06-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-06-01 0
Total participants 2016-06-01 4
Number of participants with account balances 2016-06-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-06-01 0
2015: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-06-01 4
Total number of active participants reported on line 7a of the Form 5500 2015-06-01 4
Number of retired or separated participants receiving benefits 2015-06-01 0
Number of other retired or separated participants entitled to future benefits 2015-06-01 0
Total of all active and inactive participants 2015-06-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-06-01 0
Total participants 2015-06-01 4
Number of participants with account balances 2015-06-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-06-01 0
2014: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-06-01 4
Total number of active participants reported on line 7a of the Form 5500 2014-06-01 4
Number of retired or separated participants receiving benefits 2014-06-01 0
Number of other retired or separated participants entitled to future benefits 2014-06-01 0
Total of all active and inactive participants 2014-06-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-06-01 0
Total participants 2014-06-01 4
Number of participants with account balances 2014-06-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-06-01 0
2013: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-06-01 3
Total number of active participants reported on line 7a of the Form 5500 2013-06-01 4
Number of retired or separated participants receiving benefits 2013-06-01 0
Number of other retired or separated participants entitled to future benefits 2013-06-01 0
Total of all active and inactive participants 2013-06-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-06-01 0
Total participants 2013-06-01 4
Number of participants with account balances 2013-06-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-06-01 0
2012: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-06-01 4
Total number of active participants reported on line 7a of the Form 5500 2012-06-01 3
Number of retired or separated participants receiving benefits 2012-06-01 0
Number of other retired or separated participants entitled to future benefits 2012-06-01 0
Total of all active and inactive participants 2012-06-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-06-01 0
Total participants 2012-06-01 3
Number of participants with account balances 2012-06-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-06-01 0
2011: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-06-01 4
Total number of active participants reported on line 7a of the Form 5500 2011-06-01 4
Number of retired or separated participants receiving benefits 2011-06-01 0
Number of other retired or separated participants entitled to future benefits 2011-06-01 0
Total of all active and inactive participants 2011-06-01 4
Total participants 2011-06-01 4
Number of participants with account balances 2011-06-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-06-01 0
2009: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-06-01 4
Total number of active participants reported on line 7a of the Form 5500 2009-06-01 4
Number of retired or separated participants receiving benefits 2009-06-01 0
Number of other retired or separated participants entitled to future benefits 2009-06-01 0
Total of all active and inactive participants 2009-06-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-06-01 0
Total participants 2009-06-01 4
Number of participants with account balances 2009-06-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-06-01 0

Measure	Date	Value
2017: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-06-01	4
Total number of active participants reported on line 7a of the Form 5500	2017-06-01	0
Number of retired or separated participants receiving benefits	2017-06-01	0
Number of other retired or separated participants entitled to future benefits	2017-06-01	0
Total of all active and inactive participants	2017-06-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-06-01	0
Total participants	2017-06-01	0
Number of participants with account balances	2017-06-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-06-01	0
2016: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-06-01	4
Total number of active participants reported on line 7a of the Form 5500	2016-06-01	4
Number of retired or separated participants receiving benefits	2016-06-01	0
Number of other retired or separated participants entitled to future benefits	2016-06-01	0
Total of all active and inactive participants	2016-06-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-06-01	0
Total participants	2016-06-01	4
Number of participants with account balances	2016-06-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-06-01	0
2015: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-06-01	4
Total number of active participants reported on line 7a of the Form 5500	2015-06-01	4
Number of retired or separated participants receiving benefits	2015-06-01	0
Number of other retired or separated participants entitled to future benefits	2015-06-01	0
Total of all active and inactive participants	2015-06-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-06-01	0
Total participants	2015-06-01	4
Number of participants with account balances	2015-06-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-06-01	0
2014: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-06-01	4
Total number of active participants reported on line 7a of the Form 5500	2014-06-01	4
Number of retired or separated participants receiving benefits	2014-06-01	0
Number of other retired or separated participants entitled to future benefits	2014-06-01	0
Total of all active and inactive participants	2014-06-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-06-01	0
Total participants	2014-06-01	4
Number of participants with account balances	2014-06-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-06-01	0
2013: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-06-01	3
Total number of active participants reported on line 7a of the Form 5500	2013-06-01	4
Number of retired or separated participants receiving benefits	2013-06-01	0
Number of other retired or separated participants entitled to future benefits	2013-06-01	0
Total of all active and inactive participants	2013-06-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-06-01	0
Total participants	2013-06-01	4
Number of participants with account balances	2013-06-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-06-01	0
2012: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-06-01	4
Total number of active participants reported on line 7a of the Form 5500	2012-06-01	3
Number of retired or separated participants receiving benefits	2012-06-01	0
Number of other retired or separated participants entitled to future benefits	2012-06-01	0
Total of all active and inactive participants	2012-06-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-06-01	0
Total participants	2012-06-01	3
Number of participants with account balances	2012-06-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-06-01	0
2011: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-06-01	4
Total number of active participants reported on line 7a of the Form 5500	2011-06-01	4
Number of retired or separated participants receiving benefits	2011-06-01	0
Number of other retired or separated participants entitled to future benefits	2011-06-01	0
Total of all active and inactive participants	2011-06-01	4
Total participants	2011-06-01	4
Number of participants with account balances	2011-06-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-06-01	0
2009: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-06-01	4
Total number of active participants reported on line 7a of the Form 5500	2009-06-01	4
Number of retired or separated participants receiving benefits	2009-06-01	0
Number of other retired or separated participants entitled to future benefits	2009-06-01	0
Total of all active and inactive participants	2009-06-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-06-01	0
Total participants	2009-06-01	4
Number of participants with account balances	2009-06-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-06-01	0

Financial Data on PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN

Measure	Date	Value
2018 : PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2018 401k financial data
Total plan liabilities at beginning of year	2018-05-31	$0
Total income from all sources	2018-05-31	$37,085
Expenses. Total of all expenses incurred	2018-05-31	$899,563
Benefits paid (including direct rollovers)	2018-05-31	$899,563
Total plan assets at beginning of year	2018-05-31	$862,478
Value of fidelity bond covering the plan	2018-05-31	$85,000
Other income received	2018-05-31	$37,085
Net income (gross income less expenses)	2018-05-31	$-862,478
Net plan assets at beginning of year (total assets less liabilities)	2018-05-31	$862,478
2017 : PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2017 401k financial data
Total plan liabilities at beginning of year	2017-05-31	$0
Total income from all sources	2017-05-31	$61,465
Total plan assets at end of year	2017-05-31	$862,478
Total plan assets at beginning of year	2017-05-31	$801,013
Value of fidelity bond covering the plan	2017-05-31	$85,000
Other income received	2017-05-31	$47,501
Net income (gross income less expenses)	2017-05-31	$61,465
Net plan assets at end of year (total assets less liabilities)	2017-05-31	$862,478
Net plan assets at beginning of year (total assets less liabilities)	2017-05-31	$801,013
Total contributions received or receivable from employer(s)	2017-05-31	$13,964
2016 : PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at beginning of year	2016-05-31	$0
Total income from all sources	2016-05-31	$42,925
Total plan assets at end of year	2016-05-31	$801,013
Total plan assets at beginning of year	2016-05-31	$758,088
Value of fidelity bond covering the plan	2016-05-31	$85,000
Other income received	2016-05-31	$26,865
Net income (gross income less expenses)	2016-05-31	$42,925
Net plan assets at end of year (total assets less liabilities)	2016-05-31	$801,013
Net plan assets at beginning of year (total assets less liabilities)	2016-05-31	$758,088
Total contributions received or receivable from employer(s)	2016-05-31	$16,060
2015 : PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2015 401k financial data
Total plan liabilities at beginning of year	2015-05-31	$0
Total income from all sources	2015-05-31	$53,703
Total plan assets at end of year	2015-05-31	$758,088
Total plan assets at beginning of year	2015-05-31	$704,385
Value of fidelity bond covering the plan	2015-05-31	$75,000
Other income received	2015-05-31	$35,305
Net income (gross income less expenses)	2015-05-31	$53,703
Net plan assets at end of year (total assets less liabilities)	2015-05-31	$758,088
Net plan assets at beginning of year (total assets less liabilities)	2015-05-31	$704,385
Total contributions received or receivable from employer(s)	2015-05-31	$18,398
2014 : PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at beginning of year	2014-05-31	$0
Total income from all sources	2014-05-31	$66,022
Total plan assets at end of year	2014-05-31	$704,385
Total plan assets at beginning of year	2014-05-31	$638,363
Value of fidelity bond covering the plan	2014-05-31	$75,000
Other income received	2014-05-31	$48,822
Net income (gross income less expenses)	2014-05-31	$66,022
Net plan assets at end of year (total assets less liabilities)	2014-05-31	$704,385
Net plan assets at beginning of year (total assets less liabilities)	2014-05-31	$638,363
Total contributions received or receivable from employer(s)	2014-05-31	$17,200
2013 : PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at beginning of year	2013-05-31	$0
Total income from all sources	2013-05-31	$66,198
Expenses. Total of all expenses incurred	2013-05-31	$24,949
Benefits paid (including direct rollovers)	2013-05-31	$24,949
Total plan assets at end of year	2013-05-31	$638,363
Total plan assets at beginning of year	2013-05-31	$597,114
Value of fidelity bond covering the plan	2013-05-31	$75,000
Other income received	2013-05-31	$47,595
Net income (gross income less expenses)	2013-05-31	$41,249
Net plan assets at end of year (total assets less liabilities)	2013-05-31	$638,363
Net plan assets at beginning of year (total assets less liabilities)	2013-05-31	$597,114
Total contributions received or receivable from employer(s)	2013-05-31	$18,603
2012 : PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at beginning of year	2012-05-31	$0
Total income from all sources	2012-05-31	$31,076
Total plan assets at end of year	2012-05-31	$597,114
Total plan assets at beginning of year	2012-05-31	$566,038
Value of fidelity bond covering the plan	2012-05-31	$75,000
Other income received	2012-05-31	$14,021
Net income (gross income less expenses)	2012-05-31	$31,076
Net plan assets at end of year (total assets less liabilities)	2012-05-31	$597,114
Net plan assets at beginning of year (total assets less liabilities)	2012-05-31	$566,038
Total contributions received or receivable from employer(s)	2012-05-31	$17,055
2011 : PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2011 401k financial data
Total plan liabilities at beginning of year	2011-05-31	$0
Total income from all sources	2011-05-31	$53,097
Total plan assets at end of year	2011-05-31	$566,038
Total plan assets at beginning of year	2011-05-31	$512,941
Value of fidelity bond covering the plan	2011-05-31	$75,000
Other income received	2011-05-31	$36,447
Net income (gross income less expenses)	2011-05-31	$53,097
Net plan assets at end of year (total assets less liabilities)	2011-05-31	$566,038
Net plan assets at beginning of year (total assets less liabilities)	2011-05-31	$512,941
Total contributions received or receivable from employer(s)	2011-05-31	$16,650

Form 5500 Responses for PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN

2017: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2017 form 5500 responses
2017-06-01	Type of plan entity	Single employer plan
2017-06-01	This submission is the final filing	Yes
2017-06-01	Plan funding arrangement – Insurance	Yes
2017-06-01	Plan funding arrangement – Trust	Yes
2017-06-01	Plan benefit arrangement – Insurance	Yes
2017-06-01	Plan benefit arrangement - Trust	Yes
2016: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2016 form 5500 responses
2016-06-01	Type of plan entity	Single employer plan
2016-06-01	Plan funding arrangement – Insurance	Yes
2016-06-01	Plan funding arrangement – Trust	Yes
2016-06-01	Plan benefit arrangement – Insurance	Yes
2016-06-01	Plan benefit arrangement - Trust	Yes
2015: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2015 form 5500 responses
2015-06-01	Type of plan entity	Single employer plan
2015-06-01	Plan funding arrangement – Insurance	Yes
2015-06-01	Plan funding arrangement – Trust	Yes
2015-06-01	Plan benefit arrangement – Insurance	Yes
2015-06-01	Plan benefit arrangement - Trust	Yes
2014: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2014 form 5500 responses
2014-06-01	Type of plan entity	Single employer plan
2014-06-01	Plan funding arrangement – Insurance	Yes
2014-06-01	Plan funding arrangement – Trust	Yes
2014-06-01	Plan benefit arrangement – Insurance	Yes
2014-06-01	Plan benefit arrangement - Trust	Yes
2013: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2013 form 5500 responses
2013-06-01	Type of plan entity	Single employer plan
2013-06-01	Plan funding arrangement – Insurance	Yes
2013-06-01	Plan funding arrangement – Trust	Yes
2013-06-01	Plan benefit arrangement – Insurance	Yes
2013-06-01	Plan benefit arrangement - Trust	Yes
2012: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2012 form 5500 responses
2012-06-01	Type of plan entity	Single employer plan
2012-06-01	Plan funding arrangement – Insurance	Yes
2012-06-01	Plan funding arrangement – Trust	Yes
2012-06-01	Plan benefit arrangement – Insurance	Yes
2012-06-01	Plan benefit arrangement - Trust	Yes
2011: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2011 form 5500 responses
2011-06-01	Type of plan entity	Single employer plan
2011-06-01	Plan funding arrangement – Insurance	Yes
2011-06-01	Plan funding arrangement – Trust	Yes
2011-06-01	Plan benefit arrangement – Insurance	Yes
2011-06-01	Plan benefit arrangement - Trust	Yes
2009: PETER BOTTAR DO INC EMPLOYEES PROFIT SHARING PLAN 2009 form 5500 responses
2009-06-01	Type of plan entity	Single employer plan
2009-06-01	Plan funding arrangement – Insurance	Yes
2009-06-01	Plan funding arrangement – Trust	Yes
2009-06-01	Plan benefit arrangement – Insurance	Yes
2009-06-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63665 )

Policy contract number

12866

Policy instance

Insurance contract or identification number	12866
Number of Individuals Covered	1
Insurance policy start date	2017-06-01
Insurance policy end date	2018-05-31

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63665 )

Policy contract number

12866

Policy instance

Insurance contract or identification number	12866
Number of Individuals Covered	1
Insurance policy start date	2015-06-01
Insurance policy end date	2016-05-31

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63665 )

Policy contract number

12866

Policy instance

Insurance contract or identification number	12866
Number of Individuals Covered	1
Insurance policy start date	2014-06-01
Insurance policy end date	2015-05-31

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63665 )

Policy contract number

12866

Policy instance

Insurance contract or identification number	12866
Number of Individuals Covered	1
Insurance policy start date	2013-06-01
Insurance policy end date	2014-05-31

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63665 )

Policy contract number

12866

Policy instance

Insurance contract or identification number	12866
Number of Individuals Covered	1
Insurance policy start date	2012-06-01
Insurance policy end date	2013-05-31

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63665 )

Policy contract number

12866

Policy instance

Insurance contract or identification number	12866
Number of Individuals Covered	1
Insurance policy start date	2011-06-01
Insurance policy end date	2012-05-31

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63665 )

Policy contract number

12866

Policy instance

Insurance contract or identification number	12866
Number of Individuals Covered	1
Insurance policy start date	2010-06-01
Insurance policy end date	2011-05-31

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Company Name:	PETER BOTTAR DO INC.
Employer identification number (EIN):	341315037
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)