401k Plan data: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST plan

ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST
Plan identification number	002

ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

ARTURO BETANCOURT MD PA has sponsored the creation of one or more 401k plans.

Company Name: ARTURO BETANCOURT MD PA

Employer identification number (EIN): 522032553

NAIC Classification: 621320
NAIC Description: Offices of Optometrists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01
002 2018-01-01
002 2017-01-01
002 2016-01-01 JEFFREY R TRIMMER 2017-05-30 ARTURO E BETANCOURT MD PA 2017-05-30
002 2016-01-01 JEFFREY R TRIMMER 2017-05-30 ARTURO E BETANCOURT MD PA 2017-05-30
002 2016-01-01 JEFFREY R TRIMMER 2017-05-30
002 2015-01-01 JEFFREY TRIMMER 2016-06-07
002 2014-01-01 JEFFREY R TRIMMER
002 2014-01-01 2015-06-25
002 2013-01-01 JEFFREY TRIMMER
002 2012-01-01 PHILLIP HARRINGTON
002 2011-01-01 PHILLIP HARRINGTON
002 2010-01-01 PHILLIP HARRINGTON
002 2009-01-01 PHILLIP HARRINGTON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01
002	2016-01-01	JEFFREY R TRIMMER	2017-05-30	ARTURO E BETANCOURT MD PA	2017-05-30
002	2016-01-01	JEFFREY R TRIMMER	2017-05-30	ARTURO E BETANCOURT MD PA	2017-05-30
002	2016-01-01	JEFFREY R TRIMMER	2017-05-30
002	2015-01-01	JEFFREY TRIMMER	2016-06-07
002	2014-01-01	JEFFREY R TRIMMER
002	2014-01-01		2015-06-25
002	2013-01-01	JEFFREY TRIMMER
002	2012-01-01	PHILLIP HARRINGTON
002	2011-01-01	PHILLIP HARRINGTON
002	2010-01-01	PHILLIP HARRINGTON
002	2009-01-01	PHILLIP HARRINGTON

Plan Statistics for ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST

Measure Date Value
2014: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 55
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 51
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 26
Total of all active and inactive participants 2014-01-01 78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 78
Number of participants with account balances 2014-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 59
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 48
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 24
Total of all active and inactive participants 2013-01-01 72
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 72
Number of participants with account balances 2013-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 15
2012: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 58
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 35
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 21
Total of all active and inactive participants 2012-01-01 56
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 56
Number of participants with account balances 2012-01-01 35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 16
2011: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 57
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 40
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 10
Total of all active and inactive participants 2011-01-01 50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 50
Number of participants with account balances 2011-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 47
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 29
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 19
Total of all active and inactive participants 2010-01-01 48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 48
Number of participants with account balances 2010-01-01 48
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 54
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 37
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 13
Total of all active and inactive participants 2009-01-01 50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 50
Number of participants with account balances 2009-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 3

Measure	Date	Value
2014: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	55
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	51
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	26
Total of all active and inactive participants	2014-01-01	78
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	78
Number of participants with account balances	2014-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	59
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	48
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	24
Total of all active and inactive participants	2013-01-01	72
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	72
Number of participants with account balances	2013-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	15
2012: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	58
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	35
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	21
Total of all active and inactive participants	2012-01-01	56
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	56
Number of participants with account balances	2012-01-01	35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	16
2011: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	57
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	40
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	10
Total of all active and inactive participants	2011-01-01	50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	50
Number of participants with account balances	2011-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	47
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	29
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	19
Total of all active and inactive participants	2010-01-01	48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	48
Number of participants with account balances	2010-01-01	48
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	54
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	37
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	13
Total of all active and inactive participants	2009-01-01	50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	50
Number of participants with account balances	2009-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	3

Financial Data on ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST

Measure	Date	Value
2014 : ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2014 401k financial data
Transfers to/from the plan	2014-12-31	$91
Total income from all sources	2014-12-31	$238,518
Expenses. Total of all expenses incurred	2014-12-31	$42,656
Benefits paid (including direct rollovers)	2014-12-31	$42,220
Total plan assets at end of year	2014-12-31	$2,280,788
Total plan assets at beginning of year	2014-12-31	$2,084,835
Value of fidelity bond covering the plan	2014-12-31	$120,000
Total contributions received or receivable from participants	2014-12-31	$94,705
Expenses. Other expenses not covered elsewhere	2014-12-31	$436
Contributions received from other sources (not participants or employers)	2014-12-31	$12,000
Other income received	2014-12-31	$63,664
Net income (gross income less expenses)	2014-12-31	$195,862
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$2,280,788
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$2,084,835
Assets. Value of participant loans	2014-12-31	$36,572
Total contributions received or receivable from employer(s)	2014-12-31	$68,149
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
2013 : ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$378,248
Expenses. Total of all expenses incurred	2013-12-31	$112,471
Benefits paid (including direct rollovers)	2013-12-31	$112,098
Total plan assets at end of year	2013-12-31	$2,084,835
Total plan assets at beginning of year	2013-12-31	$1,819,058
Value of fidelity bond covering the plan	2013-12-31	$120,000
Total contributions received or receivable from participants	2013-12-31	$110,501
Expenses. Other expenses not covered elsewhere	2013-12-31	$373
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$200,888
Net income (gross income less expenses)	2013-12-31	$265,777
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,084,835
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,819,058
Assets. Value of participant loans	2013-12-31	$28,917
Total contributions received or receivable from employer(s)	2013-12-31	$66,859
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
2012 : ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$363,971
Expenses. Total of all expenses incurred	2012-12-31	$139,311
Benefits paid (including direct rollovers)	2012-12-31	$134,790
Total plan assets at end of year	2012-12-31	$1,819,058
Total plan assets at beginning of year	2012-12-31	$1,594,398
Value of fidelity bond covering the plan	2012-12-31	$120,000
Total contributions received or receivable from participants	2012-12-31	$119,009
Expenses. Other expenses not covered elsewhere	2012-12-31	$673
Contributions received from other sources (not participants or employers)	2012-12-31	$3,167
Other income received	2012-12-31	$175,611
Net income (gross income less expenses)	2012-12-31	$224,660
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,819,058
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,594,398
Assets. Value of participant loans	2012-12-31	$36,354
Total contributions received or receivable from employer(s)	2012-12-31	$66,184
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$3,848
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
2011 : ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$157,040
Expenses. Total of all expenses incurred	2011-12-31	$13,841
Benefits paid (including direct rollovers)	2011-12-31	$13,435
Total plan assets at end of year	2011-12-31	$1,594,398
Total plan assets at beginning of year	2011-12-31	$1,451,199
Value of fidelity bond covering the plan	2011-12-31	$120,000
Total contributions received or receivable from participants	2011-12-31	$145,685
Expenses. Other expenses not covered elsewhere	2011-12-31	$406
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-59,644
Net income (gross income less expenses)	2011-12-31	$143,199
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,594,398
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,451,199
Assets. Value of participant loans	2011-12-31	$30,348
Total contributions received or receivable from employer(s)	2011-12-31	$70,999
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2010 401k financial data
Transfers to/from the plan	2010-12-31	$1
Total income from all sources	2010-12-31	$339,121
Expenses. Total of all expenses incurred	2010-12-31	$22,129
Benefits paid (including direct rollovers)	2010-12-31	$21,546
Total plan assets at end of year	2010-12-31	$1,451,199
Total plan assets at beginning of year	2010-12-31	$1,134,206
Value of fidelity bond covering the plan	2010-12-31	$120,000
Total contributions received or receivable from participants	2010-12-31	$115,953
Expenses. Other expenses not covered elsewhere	2010-12-31	$583
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$152,566
Net income (gross income less expenses)	2010-12-31	$316,992
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,451,199
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,134,206
Assets. Value of participant loans	2010-12-31	$32,802
Total contributions received or receivable from employer(s)	2010-12-31	$70,602
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
2009 : ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST

2014: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	Yes
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: ARTURO BETANCOURT MD PA 401(K) PROFIT SHARING PLAN & TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-712061

Policy instance

Insurance contract or identification number	GA-712061
Number of Individuals Covered	50
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,312
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,312
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY INC

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

Policy contract number

GA-712061

Policy instance

Insurance contract or identification number	GA-712061
Number of Individuals Covered	50
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,437
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,437
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY

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

Policy contract number

GA-712061

Policy instance

Insurance contract or identification number	GA-712061
Number of Individuals Covered	50
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,309
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GA-712061

Policy instance

Insurance contract or identification number	GA-712061
Number of Individuals Covered	48
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,623
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,623
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY

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Company Name:	ARTURO BETANCOURT MD PA
Employer identification number (EIN):	522032553
NAIC Classification:	621320
NAIC Description:	Offices of Optometrists