401k Plan data: GEORGETOWN PEDIATRICS PC PS PLAN plan

GEORGETOWN PEDIATRICS PC PS PLAN 401k Plan overview

Plan Name	GEORGETOWN PEDIATRICS PC PS PLAN
Plan identification number	001

GEORGETOWN PEDIATRICS PC PS PLAN 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

GEORGETOWN PEDIATRICS has sponsored the creation of one or more 401k plans.

Company Name: GEORGETOWN PEDIATRICS

Employer identification number (EIN): 581432536

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GEORGETOWN PEDIATRICS PC PS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 DARLENE ROPELEWSKI 2023-10-13
001 2021-01-01 DARLENE ROPELEWSKI 2022-07-29
001 2020-01-01 EVA THRASIVOULOU 2021-10-07 EVA THRASIVOULOU 2021-10-07
001 2019-01-01 EVA THRASIVOULOU 2020-10-16 DOUGLAS WILLIAMS, M.D. 2020-10-16
001 2018-01-01 LESLIE O. MOSELEY 2019-10-14
001 2017-01-01 LESLIE O. MOSELEY 2019-10-14
001 2016-01-01 LESLIE O. MOSELEY 2017-10-12
001 2015-01-01 LESLIE O. MOSELEY 2016-10-13
001 2014-01-01 LESLIE O. MOSELEY
001 2013-01-01 LESLIE O. MOSELEY LESLIE O. MOSELEY 2014-10-09
001 2012-01-01 LESLIE O. MOSELEY LESLIE O. MOSELEY 2013-07-24
001 2011-01-01 LESLIE O. MOSELEY
001 2010-01-01 LESLIE O. MOSELEY
001 2009-01-01 LESLIE O. MOSELEY

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	DARLENE ROPELEWSKI	2023-10-13
001	2021-01-01	DARLENE ROPELEWSKI	2022-07-29
001	2020-01-01	EVA THRASIVOULOU	2021-10-07	EVA THRASIVOULOU	2021-10-07
001	2019-01-01	EVA THRASIVOULOU	2020-10-16	DOUGLAS WILLIAMS, M.D.	2020-10-16
001	2018-01-01	LESLIE O. MOSELEY	2019-10-14
001	2017-01-01	LESLIE O. MOSELEY	2019-10-14
001	2016-01-01	LESLIE O. MOSELEY	2017-10-12
001	2015-01-01	LESLIE O. MOSELEY	2016-10-13
001	2014-01-01	LESLIE O. MOSELEY
001	2013-01-01	LESLIE O. MOSELEY		LESLIE O. MOSELEY	2014-10-09
001	2012-01-01	LESLIE O. MOSELEY		LESLIE O. MOSELEY	2013-07-24
001	2011-01-01	LESLIE O. MOSELEY
001	2010-01-01	LESLIE O. MOSELEY
001	2009-01-01	LESLIE O. MOSELEY

Plan Statistics for GEORGETOWN PEDIATRICS PC PS PLAN

401k plan membership statisitcs for GEORGETOWN PEDIATRICS PC PS PLAN

Measure Date Value
2014: GEORGETOWN PEDIATRICS PC PS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 23
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 10
Total of all active and inactive participants 2014-01-01 33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 33
Number of participants with account balances 2014-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: GEORGETOWN PEDIATRICS PC PS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 21
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 10
Total of all active and inactive participants 2013-01-01 31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 31
Number of participants with account balances 2013-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: GEORGETOWN PEDIATRICS PC PS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 35
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 24
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 8
Total of all active and inactive participants 2012-01-01 32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 32
Number of participants with account balances 2012-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: GEORGETOWN PEDIATRICS PC PS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 24
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 11
Total of all active and inactive participants 2011-01-01 35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 35
Number of participants with account balances 2011-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: GEORGETOWN PEDIATRICS PC PS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 24
Number of retired or separated participants receiving benefits 2010-01-01 1
Number of other retired or separated participants entitled to future benefits 2010-01-01 11
Total of all active and inactive participants 2010-01-01 36
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 36
Number of participants with account balances 2010-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: GEORGETOWN PEDIATRICS PC PS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 28
Number of retired or separated participants receiving benefits 2009-01-01 1
Number of other retired or separated participants entitled to future benefits 2009-01-01 9
Total of all active and inactive participants 2009-01-01 38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 38
Number of participants with account balances 2009-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2014: GEORGETOWN PEDIATRICS PC PS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	23
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	10
Total of all active and inactive participants	2014-01-01	33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	33
Number of participants with account balances	2014-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: GEORGETOWN PEDIATRICS PC PS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	21
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	10
Total of all active and inactive participants	2013-01-01	31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	31
Number of participants with account balances	2013-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: GEORGETOWN PEDIATRICS PC PS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	35
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	24
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	8
Total of all active and inactive participants	2012-01-01	32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	32
Number of participants with account balances	2012-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: GEORGETOWN PEDIATRICS PC PS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	24
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	11
Total of all active and inactive participants	2011-01-01	35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	35
Number of participants with account balances	2011-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: GEORGETOWN PEDIATRICS PC PS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	24
Number of retired or separated participants receiving benefits	2010-01-01	1
Number of other retired or separated participants entitled to future benefits	2010-01-01	11
Total of all active and inactive participants	2010-01-01	36
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	36
Number of participants with account balances	2010-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: GEORGETOWN PEDIATRICS PC PS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	28
Number of retired or separated participants receiving benefits	2009-01-01	1
Number of other retired or separated participants entitled to future benefits	2009-01-01	9
Total of all active and inactive participants	2009-01-01	38
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	38
Number of participants with account balances	2009-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on GEORGETOWN PEDIATRICS PC PS PLAN

Measure	Date	Value
2014 : GEORGETOWN PEDIATRICS PC PS PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$310,202
Expenses. Total of all expenses incurred	2014-12-31	$56,414
Benefits paid (including direct rollovers)	2014-12-31	$56,340
Total plan assets at end of year	2014-12-31	$3,763,739
Total plan assets at beginning of year	2014-12-31	$3,509,951
Value of fidelity bond covering the plan	2014-12-31	$3,000,000
Total contributions received or receivable from participants	2014-12-31	$80,922
Other income received	2014-12-31	$173,940
Net income (gross income less expenses)	2014-12-31	$253,788
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$3,763,739
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$3,509,951
Assets. Value of participant loans	2014-12-31	$49,017
Total contributions received or receivable from employer(s)	2014-12-31	$55,340
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$74
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : GEORGETOWN PEDIATRICS PC PS PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$228
Total income from all sources	2013-12-31	$513,331
Expenses. Total of all expenses incurred	2013-12-31	$392,463
Benefits paid (including direct rollovers)	2013-12-31	$392,370
Total plan assets at end of year	2013-12-31	$3,509,951
Total plan assets at beginning of year	2013-12-31	$3,388,855
Value of fidelity bond covering the plan	2013-12-31	$3,000,000
Total contributions received or receivable from participants	2013-12-31	$81,004
Expenses. Other expenses not covered elsewhere	2013-12-31	$93
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$432,327
Net income (gross income less expenses)	2013-12-31	$120,868
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$3,509,951
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$3,388,855
Assets. Value of participant loans	2013-12-31	$109,234
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	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 : GEORGETOWN PEDIATRICS PC PS PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$264,958
Expenses. Total of all expenses incurred	2012-12-31	$197,921
Benefits paid (including direct rollovers)	2012-12-31	$185,934
Total plan assets at end of year	2012-12-31	$3,388,855
Total plan assets at beginning of year	2012-12-31	$3,321,818
Value of fidelity bond covering the plan	2012-12-31	$3,000,000
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$11,987
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$264,958
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$67,037
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$3,388,855
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$3,321,818
Assets. Value of participant loans	2012-12-31	$85,024
Total contributions received or receivable from employer(s)	2012-12-31	$0
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : GEORGETOWN PEDIATRICS PC PS PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$176,738
Expenses. Total of all expenses incurred	2011-12-31	$85,960
Benefits paid (including direct rollovers)	2011-12-31	$74,130
Total plan assets at end of year	2011-12-31	$3,321,818
Total plan assets at beginning of year	2011-12-31	$3,231,040
Value of fidelity bond covering the plan	2011-12-31	$3,000,000
Expenses. Other expenses not covered elsewhere	2011-12-31	$11,830
Other income received	2011-12-31	$26,738
Net income (gross income less expenses)	2011-12-31	$90,778
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$3,321,818
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$3,231,040
Assets. Value of participant loans	2011-12-31	$75,573
Total contributions received or receivable from employer(s)	2011-12-31	$150,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : GEORGETOWN PEDIATRICS PC PS PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$631,143
Expenses. Total of all expenses incurred	2010-12-31	$340,679
Benefits paid (including direct rollovers)	2010-12-31	$329,095
Total plan assets at end of year	2010-12-31	$3,231,040
Total plan assets at beginning of year	2010-12-31	$2,940,576
Value of fidelity bond covering the plan	2010-12-31	$3,000,000
Expenses. Other expenses not covered elsewhere	2010-12-31	$11,584
Other income received	2010-12-31	$331,143
Net income (gross income less expenses)	2010-12-31	$290,464
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$3,231,040
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,940,576
Assets. Value of participant loans	2010-12-31	$31,867
Total contributions received or receivable from employer(s)	2010-12-31	$300,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : GEORGETOWN PEDIATRICS PC PS PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for GEORGETOWN PEDIATRICS PC PS PLAN

2014: GEORGETOWN PEDIATRICS PC PS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
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: GEORGETOWN PEDIATRICS PC PS PLAN 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: GEORGETOWN PEDIATRICS PC PS PLAN 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: GEORGETOWN PEDIATRICS PC PS PLAN 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: GEORGETOWN PEDIATRICS PC PS PLAN 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 – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: GEORGETOWN PEDIATRICS PC PS PLAN 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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-832227

Policy instance

Insurance contract or identification number	GA-832227
Number of Individuals Covered	30
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $11,262
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 $11,262
Insurance broker organization code?	3
Insurance broker name	MORGAN STANLEY INS SERVICES INC

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

Policy contract number

GA-832227

Policy instance

Insurance contract or identification number	GA-832227
Number of Individuals Covered	27
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $9,141
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 $9,141
Insurance broker organization code?	3
Insurance broker name	MORGAN STANLEY INS SVCS INC

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

Policy contract number

GA-832227

Policy instance

Insurance contract or identification number	GA-832227
Number of Individuals Covered	24
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
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

Potentially related plans

GEORGETOWN PEDIATRICS, P.S.C. 401(K) PROFIT SHARING PLAN [EIN = 611215814]

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Company Name:	GEORGETOWN PEDIATRICS
Employer identification number (EIN):	581432536
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)