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MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameMIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN
Plan identification number 002

MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined 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.
  • 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS has sponsored the creation of one or more 401k plans.

Company Name:MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS
Employer identification number (EIN):363705129
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01
0022021-01-01
0022020-01-01
0022019-01-01
0022018-01-01
0022017-01-01LETICIA PEDRAZA
0022016-01-01LETICIA PEDRAZA
0022015-01-01LETICIA PEDRAZA
0022014-01-01LETICIA PEDRAZA
0022013-01-01LETICIA PEDRAZA
0022012-01-01LETICIA PEDRAZA
0022011-01-01LETICIA PEDRAZA2012-10-09
0022010-01-01LETICIA PEDRAZA2011-09-14

Plan Statistics for MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN

Measure Date Value
2022: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0149
Total number of active participants reported on line 7a of the Form 55002022-01-0136
Number of retired or separated participants receiving benefits2022-01-012
Number of other retired or separated participants entitled to future benefits2022-01-019
Total of all active and inactive participants2022-01-0147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-0147
Number of participants with account balances2022-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0157
Total number of active participants reported on line 7a of the Form 55002021-01-0136
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0112
Total of all active and inactive participants2021-01-0148
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0148
Number of participants with account balances2021-01-0141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0150
Total number of active participants reported on line 7a of the Form 55002020-01-0142
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0113
Total of all active and inactive participants2020-01-0155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0155
Number of participants with account balances2020-01-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0155
Total number of active participants reported on line 7a of the Form 55002019-01-0138
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0111
Total of all active and inactive participants2019-01-0149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0149
Number of participants with account balances2019-01-0144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0156
Total number of active participants reported on line 7a of the Form 55002018-01-0141
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0112
Total of all active and inactive participants2018-01-0153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0153
Number of participants with account balances2018-01-0147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0153
Total number of active participants reported on line 7a of the Form 55002017-01-0141
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-0110
Total of all active and inactive participants2017-01-0152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0152
Number of participants with account balances2017-01-0145
2016: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0156
Total number of active participants reported on line 7a of the Form 55002016-01-0140
Number of retired or separated participants receiving benefits2016-01-011
Number of other retired or separated participants entitled to future benefits2016-01-0111
Total of all active and inactive participants2016-01-0152
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0152
Number of participants with account balances2016-01-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0166
Total number of active participants reported on line 7a of the Form 55002015-01-0141
Number of retired or separated participants receiving benefits2015-01-011
Number of other retired or separated participants entitled to future benefits2015-01-0111
Total of all active and inactive participants2015-01-0153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0153
Number of participants with account balances2015-01-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0166
Total number of active participants reported on line 7a of the Form 55002014-01-0143
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0120
Total of all active and inactive participants2014-01-0163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0163
Number of participants with account balances2014-01-0149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0169
Total number of active participants reported on line 7a of the Form 55002013-01-0144
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0121
Total of all active and inactive participants2013-01-0165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0165
Number of participants with account balances2013-01-0152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0173
Total number of active participants reported on line 7a of the Form 55002012-01-0143
Number of retired or separated participants receiving benefits2012-01-0122
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0165
Number of participants with account balances2012-01-0152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010

Financial Data on MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN

Measure Date Value
2022 : MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$39,000
Total income from all sources2022-12-31$-1,024,063
Expenses. Total of all expenses incurred2022-12-31$698,531
Benefits paid (including direct rollovers)2022-12-31$692,006
Total plan assets at end of year2022-12-31$7,513,709
Total plan assets at beginning of year2022-12-31$9,197,303
Value of fidelity bond covering the plan2022-12-31$500,000
Total contributions received or receivable from participants2022-12-31$161,064
Other income received2022-12-31$-1,268,655
Net income (gross income less expenses)2022-12-31$-1,722,594
Net plan assets at end of year (total assets less liabilities)2022-12-31$7,474,709
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$9,197,303
Assets. Value of participant loans2022-12-31$11,480
Total contributions received or receivable from employer(s)2022-12-31$83,528
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$6,525
2021 : MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources2021-12-31$1,528,272
Expenses. Total of all expenses incurred2021-12-31$400,578
Benefits paid (including direct rollovers)2021-12-31$400,228
Total plan assets at end of year2021-12-31$9,197,303
Total plan assets at beginning of year2021-12-31$8,069,609
Value of fidelity bond covering the plan2021-12-31$500,000
Total contributions received or receivable from participants2021-12-31$158,606
Other income received2021-12-31$1,285,828
Net income (gross income less expenses)2021-12-31$1,127,694
Net plan assets at end of year (total assets less liabilities)2021-12-31$9,197,303
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$8,069,609
Assets. Value of participant loans2021-12-31$5,383
Total contributions received or receivable from employer(s)2021-12-31$83,838
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$350
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
2020 : MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources2020-12-31$1,310,159
Expenses. Total of all expenses incurred2020-12-31$135,119
Benefits paid (including direct rollovers)2020-12-31$134,809
Total plan assets at end of year2020-12-31$8,069,609
Total plan assets at beginning of year2020-12-31$6,894,569
Value of fidelity bond covering the plan2020-12-31$500,000
Total contributions received or receivable from participants2020-12-31$152,440
Other income received2020-12-31$1,120,125
Net income (gross income less expenses)2020-12-31$1,175,040
Net plan assets at end of year (total assets less liabilities)2020-12-31$8,069,609
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$6,894,569
Assets. Value of participant loans2020-12-31$15,473
Total contributions received or receivable from employer(s)2020-12-31$37,594
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources2019-12-31$1,338,257
Expenses. Total of all expenses incurred2019-12-31$70,981
Benefits paid (including direct rollovers)2019-12-31$70,531
Total plan assets at end of year2019-12-31$6,894,569
Total plan assets at beginning of year2019-12-31$5,627,293
Value of fidelity bond covering the plan2019-12-31$500,000
Total contributions received or receivable from participants2019-12-31$156,528
Other income received2019-12-31$1,094,997
Net income (gross income less expenses)2019-12-31$1,267,276
Net plan assets at end of year (total assets less liabilities)2019-12-31$6,894,569
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$5,627,293
Assets. Value of participant loans2019-12-31$24,984
Total contributions received or receivable from employer(s)2019-12-31$86,732
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$450
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources2018-12-31$3,441
Expenses. Total of all expenses incurred2018-12-31$114,336
Benefits paid (including direct rollovers)2018-12-31$113,531
Total plan assets at end of year2018-12-31$5,627,293
Total plan assets at beginning of year2018-12-31$5,738,188
Value of fidelity bond covering the plan2018-12-31$500,000
Total contributions received or receivable from participants2018-12-31$169,263
Other income received2018-12-31$-258,992
Net income (gross income less expenses)2018-12-31$-110,895
Net plan assets at end of year (total assets less liabilities)2018-12-31$5,627,293
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$5,738,188
Assets. Value of participant loans2018-12-31$66,839
Total contributions received or receivable from employer(s)2018-12-31$93,170
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$805
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total plan liabilities at beginning of year2017-12-31$260
Total income from all sources2017-12-31$1,064,879
Expenses. Total of all expenses incurred2017-12-31$9,396
Benefits paid (including direct rollovers)2017-12-31$8,606
Total plan assets at end of year2017-12-31$5,738,188
Total plan assets at beginning of year2017-12-31$4,682,965
Value of fidelity bond covering the plan2017-12-31$500,000
Total contributions received or receivable from participants2017-12-31$161,133
Contributions received from other sources (not participants or employers)2017-12-31$7,673
Other income received2017-12-31$811,993
Net income (gross income less expenses)2017-12-31$1,055,483
Net plan assets at end of year (total assets less liabilities)2017-12-31$5,738,188
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$4,682,705
Assets. Value of participant loans2017-12-31$79,734
Total contributions received or receivable from employer(s)2017-12-31$84,080
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$790
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$260
Total income from all sources2016-12-31$558,359
Expenses. Total of all expenses incurred2016-12-31$373,696
Benefits paid (including direct rollovers)2016-12-31$372,806
Total plan assets at end of year2016-12-31$4,682,965
Total plan assets at beginning of year2016-12-31$4,498,042
Value of fidelity bond covering the plan2016-12-31$469,000
Total contributions received or receivable from participants2016-12-31$156,784
Other income received2016-12-31$319,244
Net income (gross income less expenses)2016-12-31$184,663
Net plan assets at end of year (total assets less liabilities)2016-12-31$4,682,705
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$4,498,042
Assets. Value of participant loans2016-12-31$77,927
Total contributions received or receivable from employer(s)2016-12-31$82,331
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$890
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$125,802
Expenses. Total of all expenses incurred2015-12-31$136,293
Benefits paid (including direct rollovers)2015-12-31$134,993
Total plan assets at end of year2015-12-31$4,498,042
Total plan assets at beginning of year2015-12-31$4,508,533
Value of fidelity bond covering the plan2015-12-31$460,000
Total contributions received or receivable from participants2015-12-31$139,422
Other income received2015-12-31$-40,163
Net income (gross income less expenses)2015-12-31$-10,491
Net plan assets at end of year (total assets less liabilities)2015-12-31$4,498,042
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$4,508,533
Assets. Value of participant loans2015-12-31$31,851
Total contributions received or receivable from employer(s)2015-12-31$26,543
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$1,300
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$418,002
Expenses. Total of all expenses incurred2014-12-31$86,802
Total plan assets at end of year2014-12-31$4,508,533
Total plan assets at beginning of year2014-12-31$4,177,333
Value of fidelity bond covering the plan2014-12-31$460,000
Total contributions received or receivable from participants2014-12-31$133,021
Other income received2014-12-31$251,343
Net income (gross income less expenses)2014-12-31$331,200
Net plan assets at end of year (total assets less liabilities)2014-12-31$4,508,533
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$4,177,333
Assets. Value of participant loans2014-12-31$32,072
Total contributions received or receivable from employer(s)2014-12-31$33,638
Value of certain deemed distributions of participant loans2014-12-31$85,777
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$1,025
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$770,640
Expenses. Total of all expenses incurred2013-12-31$25,458
Benefits paid (including direct rollovers)2013-12-31$24,718
Total plan assets at end of year2013-12-31$4,177,333
Total plan assets at beginning of year2013-12-31$3,432,151
Value of fidelity bond covering the plan2013-12-31$420,000
Total contributions received or receivable from participants2013-12-31$128,797
Contributions received from other sources (not participants or employers)2013-12-31$1,346
Other income received2013-12-31$608,812
Net income (gross income less expenses)2013-12-31$745,182
Net plan assets at end of year (total assets less liabilities)2013-12-31$4,177,333
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$3,432,151
Assets. Value of participant loans2013-12-31$34,253
Total contributions received or receivable from employer(s)2013-12-31$31,685
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$740
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$0
Total income from all sources2012-12-31$552,706
Expenses. Total of all expenses incurred2012-12-31$26,914
Benefits paid (including direct rollovers)2012-12-31$26,074
Total plan assets at end of year2012-12-31$3,432,151
Total plan assets at beginning of year2012-12-31$2,906,359
Value of fidelity bond covering the plan2012-12-31$345,000
Total contributions received or receivable from participants2012-12-31$123,635
Other income received2012-12-31$405,786
Net income (gross income less expenses)2012-12-31$525,792
Net plan assets at end of year (total assets less liabilities)2012-12-31$3,432,151
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$2,906,359
Assets. Value of participant loans2012-12-31$35,517
Total contributions received or receivable from employer(s)2012-12-31$23,285
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$840
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0

Form 5500 Responses for MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN

2022: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: MIDWEST SPORTS MEDICINE & ORTHOPAEDIC SURGICAL SPECIALISTS, LTD. 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number000418834
Policy instance 1
Insurance contract or identification number000418834
Number of Individuals Covered1
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number000418834
Policy instance 1
Insurance contract or identification number000418834
Number of Individuals Covered1
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number000418834
Policy instance 1
Insurance contract or identification number000418834
Number of Individuals Covered1
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number000418834
Policy instance 2
Insurance contract or identification number000418834
Number of Individuals Covered1
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACCORDIA LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 62200 )
Policy contract numberB05017053
Policy instance 1
Insurance contract or identification numberB05017053
Number of Individuals Covered1
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACCORDIA LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 62200 )
Policy contract numberB05017053
Policy instance 2
Insurance contract or identification numberB05017053
Number of Individuals Covered1
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number000418834
Policy instance 1
Insurance contract or identification number000418834
Number of Individuals Covered1
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACCORDIA LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 62200 )
Policy contract numberB05017053
Policy instance 2
Insurance contract or identification numberB05017053
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number000418834
Policy instance 1
Insurance contract or identification number000418834
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ACCORDIA LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 62200 )
Policy contract numberB05017053
Policy instance 2
Insurance contract or identification numberB05017053
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number000418834
Policy instance 1
Insurance contract or identification number000418834
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN EQUITY INVESTMENT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61689 )
Policy contract numberB05017053
Policy instance 2
Insurance contract or identification numberB05017053
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number000418834
Policy instance 1
Insurance contract or identification number000418834
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN EQUITY INVESTMENT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61689 )
Policy contract numberB05017053
Policy instance 2
Insurance contract or identification numberB05017053
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number000418834
Policy instance 1
Insurance contract or identification number000418834
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN EQUITY INVESTMENT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61689 )
Policy contract numberB05017053
Policy instance 2
Insurance contract or identification numberB05017053
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number000418834
Policy instance 1
Insurance contract or identification number000418834
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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