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CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameCAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN
Plan identification number 002

CAROLINA UROLOGICAL ASSOCIATES, P.A. 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.
  • 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.
  • Life insurance

401k Sponsoring company profile

CAROLINA UROLOGICAL ASSOC. has sponsored the creation of one or more 401k plans.

Company Name:CAROLINA UROLOGICAL ASSOC.
Employer identification number (EIN):562227628
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022016-01-01GEORGE NEWSOME, M.D. GEORGE NEWSOME, M.D.2017-07-03
0022015-01-01ELIZABETH ALBERTSON ELIZABETH ALBERTSON2016-07-12
0022014-01-01ELIZABETH ALBERTSON ELIZABETH ALBERTSON2015-08-20
0022013-01-01ELIZABETH ALBERTSON
0022012-01-01ELIZABETH ALBERTSON ELIZABETH ALBERTSTON2013-09-11
0022011-01-01ELIZABETH ALBERTSON ELIZABETH ALBERTSON2012-09-27
0022010-01-01ELIZABETH ALBERTSON, MD ELIZABETH ALBERTSON, MD2011-09-28
0022009-01-01ELIZABETH ALBERTSON ELIZABETH ALBERTSON2010-10-11

Plan Statistics for CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN

Measure Date Value
2016: CAROLINA UROLOGICAL ASSOCIATES, P.A. 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 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-010
Number of participants with account balances2016-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-012
2015: CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0162
Total number of active participants reported on line 7a of the Form 55002015-01-0140
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0116
Total of all active and inactive participants2015-01-0156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0156
Number of participants with account balances2015-01-0151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-012
2014: CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0157
Total number of active participants reported on line 7a of the Form 55002014-01-0148
Number of retired or separated participants receiving benefits2014-01-011
Number of other retired or separated participants entitled to future benefits2014-01-0112
Total of all active and inactive participants2014-01-0161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0161
Number of participants with account balances2014-01-0157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-012
2013: CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0160
Total number of active participants reported on line 7a of the Form 55002013-01-0142
Number of retired or separated participants receiving benefits2013-01-011
Number of other retired or separated participants entitled to future benefits2013-01-0114
Total of all active and inactive participants2013-01-0157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0157
Number of participants with account balances2013-01-0155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-014
2012: CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0159
Total number of active participants reported on line 7a of the Form 55002012-01-0148
Number of retired or separated participants receiving benefits2012-01-011
Number of other retired or separated participants entitled to future benefits2012-01-0111
Total of all active and inactive participants2012-01-0160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0160
Number of participants with account balances2012-01-0155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-015
2011: CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0159
Total number of active participants reported on line 7a of the Form 55002011-01-0151
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-018
Total of all active and inactive participants2011-01-0159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0159
Number of participants with account balances2011-01-0151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-0112
2010: CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0160
Total number of active participants reported on line 7a of the Form 55002010-01-0155
Number of retired or separated participants receiving benefits2010-01-011
Number of other retired or separated participants entitled to future benefits2010-01-013
Total of all active and inactive participants2010-01-0159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0159
Number of participants with account balances2010-01-0159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-012
2009: CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0159
Total number of active participants reported on line 7a of the Form 55002009-01-0156
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-014
Total of all active and inactive participants2009-01-0160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0160
Number of participants with account balances2009-01-0152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-012

Financial Data on CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN

Measure Date Value
2016 : CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$0
Total income from all sources2016-12-31$847,480
Expenses. Total of all expenses incurred2016-12-31$8,587,991
Benefits paid (including direct rollovers)2016-12-31$8,585,671
Total plan assets at end of year2016-12-31$0
Total plan assets at beginning of year2016-12-31$7,740,511
Value of fidelity bond covering the plan2016-12-31$500,000
Total contributions received or receivable from participants2016-12-31$20,271
Expenses. Other expenses not covered elsewhere2016-12-31$1,960
Contributions received from other sources (not participants or employers)2016-12-31$82,939
Other income received2016-12-31$243,430
Net income (gross income less expenses)2016-12-31$-7,740,511
Net plan assets at end of year (total assets less liabilities)2016-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$7,740,511
Total contributions received or receivable from employer(s)2016-12-31$500,840
Value of certain deemed distributions of participant loans2016-12-31$0
Value of corrective distributions2016-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$360
2015 : CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$649,829
Expenses. Total of all expenses incurred2015-12-31$203,677
Benefits paid (including direct rollovers)2015-12-31$203,057
Total plan assets at end of year2015-12-31$7,740,511
Total plan assets at beginning of year2015-12-31$7,294,359
Value of fidelity bond covering the plan2015-12-31$500,000
Total contributions received or receivable from participants2015-12-31$59,842
Expenses. Other expenses not covered elsewhere2015-12-31$0
Contributions received from other sources (not participants or employers)2015-12-31$0
Other income received2015-12-31$20,804
Net income (gross income less expenses)2015-12-31$446,152
Net plan assets at end of year (total assets less liabilities)2015-12-31$7,740,511
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$7,294,359
Assets. Value of participant loans2015-12-31$15,067
Total contributions received or receivable from employer(s)2015-12-31$569,183
Value of certain deemed distributions of participant loans2015-12-31$0
Value of corrective distributions2015-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$620
2014 : CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-12-31$1,133,657
Expenses. Total of all expenses incurred2014-12-31$124,114
Benefits paid (including direct rollovers)2014-12-31$123,479
Total plan assets at end of year2014-12-31$7,294,359
Total plan assets at beginning of year2014-12-31$6,284,816
Value of fidelity bond covering the plan2014-12-31$500,000
Total contributions received or receivable from participants2014-12-31$41,542
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$3,161
Other income received2014-12-31$500,213
Net income (gross income less expenses)2014-12-31$1,009,543
Net plan assets at end of year (total assets less liabilities)2014-12-31$7,294,359
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$6,284,816
Assets. Value of participant loans2014-12-31$26,776
Total contributions received or receivable from employer(s)2014-12-31$588,741
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$635
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-12-31$1,605,488
Expenses. Total of all expenses incurred2013-12-31$977,365
Benefits paid (including direct rollovers)2013-12-31$976,800
Total plan assets at end of year2013-12-31$6,284,816
Total plan assets at beginning of year2013-12-31$5,656,693
Value of fidelity bond covering the plan2013-12-31$5,000,000
Total contributions received or receivable from participants2013-12-31$46,537
Expenses. Other expenses not covered elsewhere2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$2,392
Other income received2013-12-31$969,230
Net income (gross income less expenses)2013-12-31$628,123
Net plan assets at end of year (total assets less liabilities)2013-12-31$6,284,816
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$5,656,693
Assets. Value of participant loans2013-12-31$37,127
Total contributions received or receivable from employer(s)2013-12-31$587,329
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$565
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-12-31$1,419,284
Expenses. Total of all expenses incurred2012-12-31$693,264
Benefits paid (including direct rollovers)2012-12-31$692,944
Total plan assets at end of year2012-12-31$5,656,693
Total plan assets at beginning of year2012-12-31$4,930,673
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$62,689
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$260,150
Other income received2012-12-31$532,787
Net income (gross income less expenses)2012-12-31$726,020
Net plan assets at end of year (total assets less liabilities)2012-12-31$5,656,693
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$4,930,673
Assets. Value of participant loans2012-12-31$43,792
Total contributions received or receivable from employer(s)2012-12-31$563,658
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$320
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$648,290
Expenses. Total of all expenses incurred2011-12-31$1,523,869
Benefits paid (including direct rollovers)2011-12-31$1,522,729
Total plan assets at end of year2011-12-31$4,930,673
Total plan assets at beginning of year2011-12-31$5,806,252
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$33,713
Expenses. Other expenses not covered elsewhere2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$1,188
Net income (gross income less expenses)2011-12-31$-875,579
Net plan assets at end of year (total assets less liabilities)2011-12-31$4,930,673
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$5,806,252
Assets. Value of participant loans2011-12-31$54,646
Total contributions received or receivable from employer(s)2011-12-31$613,389
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$1,140
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources2010-12-31$1,200,302
Expenses. Total of all expenses incurred2010-12-31$147,861
Benefits paid (including direct rollovers)2010-12-31$147,536
Total plan assets at end of year2010-12-31$5,806,252
Total plan assets at beginning of year2010-12-31$4,753,811
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$43,829
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$44,964
Other income received2010-12-31$523,957
Net income (gross income less expenses)2010-12-31$1,052,441
Net plan assets at end of year (total assets less liabilities)2010-12-31$5,806,252
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$4,753,811
Assets. Value of participant loans2010-12-31$3,756
Total contributions received or receivable from employer(s)2010-12-31$587,552
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$325
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0

Form 5500 Responses for CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN

2016: CAROLINA UROLOGICAL ASSOCIATES, P.A. 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 filingYes
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: CAROLINA UROLOGICAL ASSOCIATES, P.A. 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: CAROLINA UROLOGICAL ASSOCIATES, P.A. 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: CAROLINA UROLOGICAL ASSOCIATES, P.A. 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: CAROLINA UROLOGICAL ASSOCIATES, P.A. 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: CAROLINA UROLOGICAL ASSOCIATES, P.A. 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
2010: CAROLINA UROLOGICAL ASSOCIATES, P.A. 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: CAROLINA UROLOGICAL ASSOCIATES, P.A. 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 – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
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 numberFL 52133
Policy instance 1
Insurance contract or identification numberFL 52133
Number of Individuals Covered56
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $22,674
Total amount of fees paid to insurance companyUSD $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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,122
Insurance broker organization code?3
Insurance broker nameNICHOLAS B GAVALAS
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberFL 52133
Policy instance 1
Insurance contract or identification numberFL 52133
Number of Individuals Covered61
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $19,958
Total amount of fees paid to insurance companyUSD $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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,658
Insurance broker organization code?3
Insurance broker nameNICHOLAS B GAVALAS
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number005645735
Policy instance 2
Insurance contract or identification number005645735
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
Other welfare benefits providedN/A
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameRICHARD E ROSE
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberFL 52133
Policy instance 1
Insurance contract or identification numberFL 52133
Number of Individuals Covered57
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $17,875
Total amount of fees paid to insurance companyUSD $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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,352
Insurance broker organization code?3
Insurance broker nameWILLIAM TAYLOR CAMPBELL
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberFL 52133
Policy instance 1
Insurance contract or identification numberFL 52133
Number of Individuals Covered60
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $16,734
Total amount of fees paid to insurance companyUSD $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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,817
Insurance broker organization code?3
Insurance broker nameWILLIAM CAMPBELL
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number005645735
Policy instance 2
Insurance contract or identification number005645735
Number of Individuals Covered2
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number0056445735
Policy instance 1
Insurance contract or identification number0056445735
Number of Individuals Covered2
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberFL 52133
Policy instance 2
Insurance contract or identification numberFL 52133
Number of Individuals Covered59
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $16,763
Total amount of fees paid to insurance companyUSD $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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number005645735
Policy instance 1
Insurance contract or identification number005645735
Number of Individuals Covered2
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
Insurance broker organization code?3
Insurance broker nameROSE RICHARD E.
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberFL 52133
Policy instance 2
Insurance contract or identification numberFL 52133
Number of Individuals Covered59
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $22,309
Total amount of fees paid to insurance companyUSD $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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,855
Insurance broker organization code?3
Insurance broker nameNICHOLAS B GAVALAS

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