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TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameTIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN
Plan identification number 001

TIDEWATER EYE CENTERS 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

TIDEWATER EYE CENTERS, P.C. has sponsored the creation of one or more 401k plans.

Company Name:TIDEWATER EYE CENTERS, P.C.
Employer identification number (EIN):541890466
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Additional information about TIDEWATER EYE CENTERS, P.C.

Jurisdiction of Incorporation: Virginia Secretary of State
Incorporation Date: 1998-03-25
Company Identification Number: 0500445
Legal Registered Office Address: 3235 ACADEMY AVENUE
150 W MAIN ST STE 2100
PORTSMOUTH
United States of America (USA)
23703

More information about TIDEWATER EYE CENTERS, P.C.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01ROGER NEWSOM2018-10-15
0012016-01-01DR. ROGER NEWSOM2017-09-28
0012015-01-01DR. WAYNE R. DEVANTIER
0012014-01-01DR. WAYNE R. DEVANTIER
0012014-01-01DR. WAYNE R. DEVANTIER
0012013-01-01DR. WAYNE R. DEVANTIER
0012012-01-01WAYNE DEVANTIER
0012011-01-01WAYNE DEVANTIER
0012009-01-01RACHEL KITCHEN

Plan Statistics for TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN

Measure Date Value
2015: TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01121
Total number of active participants reported on line 7a of the Form 55002015-01-0164
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0151
Total of all active and inactive participants2015-01-01115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01115
Number of participants with account balances2015-01-0166
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-016
2014: TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01125
Total number of active participants reported on line 7a of the Form 55002014-01-0169
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0147
Total of all active and inactive participants2014-01-01116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01116
Number of participants with account balances2014-01-01104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-0114
2013: TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01115
Total number of active participants reported on line 7a of the Form 55002013-01-0171
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0148
Total of all active and inactive participants2013-01-01119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01119
Number of participants with account balances2013-01-01106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-0111
2012: TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01102
Total number of active participants reported on line 7a of the Form 55002012-01-0164
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0142
Total of all active and inactive participants2012-01-01106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01106
Number of participants with account balances2012-01-0197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-019
2011: TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0179
Total number of active participants reported on line 7a of the Form 55002011-01-0166
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0130
Total of all active and inactive participants2011-01-0196
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0196
Number of participants with account balances2011-01-0196
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-019
2009: TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0167
Total number of active participants reported on line 7a of the Form 55002009-01-0155
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0112
Total of all active and inactive participants2009-01-0167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0167
Number of participants with account balances2009-01-0165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-013

Financial Data on TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN

Measure Date Value
2015 : TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$516,149
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$211,923
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$191,136
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$553,676
Value of total assets at end of year2015-12-31$11,329,482
Value of total assets at beginning of year2015-12-31$11,025,256
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$20,787
Total interest from all sources2015-12-31$2,390
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$227,677
Participant contributions at end of year2015-12-31$41,409
Participant contributions at beginning of year2015-12-31$60,247
Participant contributions at end of year2015-12-31$1,883
Assets. Other investments not covered elsewhere at end of year2015-12-31$5,044,978
Other income not declared elsewhere2015-12-31$-5,754
Administrative expenses (other) incurred2015-12-31$20,787
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$304,226
Value of net assets at end of year (total assets less liabilities)2015-12-31$11,329,482
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$11,025,256
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$5,915,213
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$10,637,828
Interest on participant loans2015-12-31$2,390
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-34,163
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$325,999
Employer contributions (assets) at end of year2015-12-31$325,999
Employer contributions (assets) at beginning of year2015-12-31$327,181
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$191,136
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31CHARLES W. SNADER, PC
Accountancy firm EIN2015-12-31541873714
2014 : TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$1,221,498
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$70,853
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$69,780
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$578,686
Value of total assets at end of year2014-12-31$11,025,256
Value of total assets at beginning of year2014-12-31$9,874,611
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$1,073
Total interest from all sources2014-12-31$2,899
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$254,877
Participant contributions at end of year2014-12-31$60,247
Participant contributions at beginning of year2014-12-31$72,599
Administrative expenses (other) incurred2014-12-31$1,073
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$1,150,645
Value of net assets at end of year (total assets less liabilities)2014-12-31$11,025,256
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$9,874,611
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$10,637,828
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$9,473,293
Interest on participant loans2014-12-31$2,899
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$639,913
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$323,809
Employer contributions (assets) at end of year2014-12-31$327,181
Employer contributions (assets) at beginning of year2014-12-31$328,719
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$69,780
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31CHARLES W. SNADER, PC
Accountancy firm EIN2014-12-31541873714
2013 : TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-12-31$1,798,382
Expenses. Total of all expenses incurred2013-12-31$147,231
Benefits paid (including direct rollovers)2013-12-31$141,406
Total plan assets at end of year2013-12-31$9,874,612
Total plan assets at beginning of year2013-12-31$8,223,461
Value of fidelity bond covering the plan2013-12-31$500,000
Total contributions received or receivable from participants2013-12-31$224,202
Other income received2013-12-31$1,245,461
Net income (gross income less expenses)2013-12-31$1,651,151
Net plan assets at end of year (total assets less liabilities)2013-12-31$9,874,612
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$8,223,461
Assets. Value of participant loans2013-12-31$72,599
Total contributions received or receivable from employer(s)2013-12-31$328,719
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$5,825
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-12-31$1,295,343
Expenses. Total of all expenses incurred2012-12-31$216,846
Benefits paid (including direct rollovers)2012-12-31$216,366
Total plan assets at end of year2012-12-31$8,223,461
Total plan assets at beginning of year2012-12-31$7,144,964
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$205,692
Other income received2012-12-31$772,313
Net income (gross income less expenses)2012-12-31$1,078,497
Net plan assets at end of year (total assets less liabilities)2012-12-31$8,223,461
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$7,144,964
Assets. Value of participant loans2012-12-31$72,604
Total contributions received or receivable from employer(s)2012-12-31$317,338
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$480
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$338,763
Expenses. Total of all expenses incurred2011-12-31$76,385
Benefits paid (including direct rollovers)2011-12-31$72,501
Total plan assets at end of year2011-12-31$7,144,964
Total plan assets at beginning of year2011-12-31$6,882,586
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$185,271
Contributions received from other sources (not participants or employers)2011-12-31$7,595
Other income received2011-12-31$-146,103
Net income (gross income less expenses)2011-12-31$262,378
Net plan assets at end of year (total assets less liabilities)2011-12-31$7,144,964
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$6,882,586
Assets. Value of participant loans2011-12-31$58,852
Total contributions received or receivable from employer(s)2011-12-31$292,000
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$3,884
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources2010-12-31$1,501,735
Expenses. Total of all expenses incurred2010-12-31$489,507
Benefits paid (including direct rollovers)2010-12-31$489,284
Total plan assets at end of year2010-12-31$6,882,586
Total plan assets at beginning of year2010-12-31$5,870,358
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$176,887
Other income received2010-12-31$1,035,588
Net income (gross income less expenses)2010-12-31$1,012,228
Net plan assets at end of year (total assets less liabilities)2010-12-31$6,882,586
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$5,870,358
Assets. Value of participant loans2010-12-31$55,974
Total contributions received or receivable from employer(s)2010-12-31$289,260
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$223
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN

2015: TIDEWATER EYE CENTERS 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: TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedYes
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: TIDEWATER EYE CENTERS 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: TIDEWATER EYE CENTERS 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
2011: TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: TIDEWATER EYE CENTERS 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberGA815143
Policy instance 1
Insurance contract or identification numberGA815143
Number of Individuals Covered106
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $16,043
Total amount of fees paid to insurance companyUSD $2,734
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
Commission paid to Insurance BrokerUSD $16,043
Insurance broker organization code?3
Amount paid for insurance broker fees2734
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker nameDIXON HUGHES GOODMAN LLP
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberGA815143
Policy instance 1
Insurance contract or identification numberGA815143
Number of Individuals Covered102
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $14,759
Total amount of fees paid to insurance companyUSD $2,460
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
Commission paid to Insurance BrokerUSD $14,759
Insurance broker organization code?3
Amount paid for insurance broker fees2460
Additional information about fees paid to insurance brokerTPA FEES
Insurance broker nameDIXON HUGHES GOODMAN LLP
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA815143
Policy instance 1
Insurance contract or identification numberGA815143
Number of Individuals Covered102
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $12,377
Total amount of fees paid to insurance companyUSD $2,063
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?Yes
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
Commission paid to Insurance BrokerUSD $12,377
Additional information about fees paid to insurance brokerCOMMISSION AND FEES
Insurance broker organization code?3
Amount paid for insurance broker fees2063
Insurance broker nameDIXON HUGHES GOODMAN, LLP
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA815143
Policy instance 1
Insurance contract or identification numberGA815143
Number of Individuals Covered97
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11,953
Total amount of fees paid to insurance companyUSD $5,985
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?Yes
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
Commission paid to Insurance BrokerUSD $11,953
Amount paid for insurance broker fees3993
Additional information about fees paid to insurance brokerCOMMISSION AND FEES
Insurance broker organization code?3
Insurance broker nameDIXON HUGHES GOODMAN, LLP
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA815143
Policy instance 1
Insurance contract or identification numberGA815143
Number of Individuals Covered80
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $11,778
Total amount of fees paid to insurance companyUSD $5,911
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?Yes
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
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA815143
Policy instance 1
Insurance contract or identification numberGA815143
Number of Individuals Covered62
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,439
Total amount of fees paid to insurance companyUSD $3,170
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?Yes
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
Commission paid to Insurance BrokerUSD $3,439
Amount paid for insurance broker fees1646
Additional information about fees paid to insurance brokerCOMMISSION AND FEES
Insurance broker organization code?3
Insurance broker nameGOODMAN & COMPANY, LLP

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