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UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameUROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN
Plan identification number 001

UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined 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.
  • 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.
  • Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

UROLOGY PROFESSIONAL ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name:UROLOGY PROFESSIONAL ASSOCIATION
Employer identification number (EIN):640503353
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Additional information about UROLOGY PROFESSIONAL ASSOCIATION

Jurisdiction of Incorporation: Mississippi Secretary of State
Incorporation Date:
Company Identification Number: 400574

More information about UROLOGY PROFESSIONAL ASSOCIATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01C. STEPHEN FARMER, II, MD2023-06-05 SUSANNA CHUNN2023-06-05
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01CLARANCE FARMER, M.D.2019-10-07
0012017-01-01
0012016-01-01CLARANCE FARMER, M.D.
0012015-01-01CLARANCE FARMER, M.D.
0012014-01-01CLARANCE FARMER, M.D.
0012013-01-01
0012012-01-01CLARENCE S FARMER2013-10-04 CLARENCE S FARMER2013-10-04
0012011-01-01J. TIMOTHY POSEY, M.D.2012-07-17 J. TIMOTHY POSEY, M.D.2012-07-17
0012010-01-01TONY PALAZZO2011-07-13 TONY PALAZZO2011-07-13

Plan Statistics for UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN

Measure Date Value
2021: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0164
Total number of active participants reported on line 7a of the Form 55002021-01-0144
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0124
Total of all active and inactive participants2021-01-0168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0168
Number of participants with account balances2021-01-0164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-012
2020: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0169
Total number of active participants reported on line 7a of the Form 55002020-01-0135
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0125
Total of all active and inactive participants2020-01-0160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0160
Number of participants with account balances2020-01-0158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-013
2019: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0151
Total number of active participants reported on line 7a of the Form 55002019-01-0131
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0124
Total of all active and inactive participants2019-01-0155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0155
Number of participants with account balances2019-01-0153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-015
2018: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0145
Total number of active participants reported on line 7a of the Form 55002018-01-0138
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-019
Total of all active and inactive participants2018-01-0147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0147
Number of participants with account balances2018-01-0147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-012
2017: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0145
Total number of active participants reported on line 7a of the Form 55002017-01-0141
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-016
Total of all active and inactive participants2017-01-0147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0147
Number of participants with account balances2017-01-0147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-011
2016: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0143
Total number of active participants reported on line 7a of the Form 55002016-01-0138
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-013
Total of all active and inactive participants2016-01-0141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0141
Number of participants with account balances2016-01-0141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0145
Total number of active participants reported on line 7a of the Form 55002015-01-0137
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-013
Total of all active and inactive participants2015-01-0140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0140
Number of participants with account balances2015-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0147
Total number of active participants reported on line 7a of the Form 55002014-01-0140
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-015
Total of all active and inactive participants2014-01-0145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0145
Number of participants with account balances2014-01-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-012
2013: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0149
Total number of active participants reported on line 7a of the Form 55002013-01-0138
Number of retired or separated participants receiving benefits2013-01-017
Total of all active and inactive participants2013-01-0145
Total participants2013-01-0145
Number of participants with account balances2013-01-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-013

Financial Data on UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN

Measure Date Value
2021 : UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources2021-12-31$2,556,881
Expenses. Total of all expenses incurred2021-12-31$497,480
Benefits paid (including direct rollovers)2021-12-31$455,113
Total plan assets at end of year2021-12-31$15,849,146
Total plan assets at beginning of year2021-12-31$13,789,745
Value of fidelity bond covering the plan2021-12-31$500,000
Total contributions received or receivable from participants2021-12-31$208,398
Contributions received from other sources (not participants or employers)2021-12-31$281,475
Other income received2021-12-31$1,757,434
Net income (gross income less expenses)2021-12-31$2,059,401
Net plan assets at end of year (total assets less liabilities)2021-12-31$15,849,146
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$13,789,745
Total contributions received or receivable from employer(s)2021-12-31$309,574
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$42,367
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
2020 : UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources2020-12-31$2,002,674
Expenses. Total of all expenses incurred2020-12-31$680,511
Benefits paid (including direct rollovers)2020-12-31$645,977
Total plan assets at end of year2020-12-31$13,789,745
Total plan assets at beginning of year2020-12-31$12,467,582
Value of fidelity bond covering the plan2020-12-31$500,000
Total contributions received or receivable from participants2020-12-31$247,075
Contributions received from other sources (not participants or employers)2020-12-31$250,977
Other income received2020-12-31$1,139,259
Net income (gross income less expenses)2020-12-31$1,322,163
Net plan assets at end of year (total assets less liabilities)2020-12-31$13,789,745
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$12,467,582
Total contributions received or receivable from employer(s)2020-12-31$365,363
Value of certain deemed distributions of participant loans2020-12-31$0
Value of corrective distributions2020-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$34,534
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources2019-12-31$2,338,875
Expenses. Total of all expenses incurred2019-12-31$421,212
Benefits paid (including direct rollovers)2019-12-31$388,924
Total plan assets at end of year2019-12-31$12,467,582
Total plan assets at beginning of year2019-12-31$10,549,919
Value of fidelity bond covering the plan2019-12-31$500,000
Total contributions received or receivable from participants2019-12-31$210,385
Contributions received from other sources (not participants or employers)2019-12-31$12,737
Other income received2019-12-31$1,995,711
Net income (gross income less expenses)2019-12-31$1,917,663
Net plan assets at end of year (total assets less liabilities)2019-12-31$12,467,582
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$10,549,919
Total contributions received or receivable from employer(s)2019-12-31$120,042
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$32,288
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources2018-12-31$-245,872
Expenses. Total of all expenses incurred2018-12-31$382,434
Benefits paid (including direct rollovers)2018-12-31$358,652
Total plan assets at end of year2018-12-31$10,549,919
Total plan assets at beginning of year2018-12-31$11,178,225
Value of fidelity bond covering the plan2018-12-31$500,000
Total contributions received or receivable from participants2018-12-31$189,685
Other income received2018-12-31$-796,776
Net income (gross income less expenses)2018-12-31$-628,306
Net plan assets at end of year (total assets less liabilities)2018-12-31$10,549,919
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$11,178,225
Assets. Value of assets in partnership/joint-venture interests2018-12-31$150,000
Total contributions received or receivable from employer(s)2018-12-31$361,219
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$23,782
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources2017-12-31$1,711,985
Expenses. Total of all expenses incurred2017-12-31$130,382
Benefits paid (including direct rollovers)2017-12-31$102,931
Total plan assets at end of year2017-12-31$11,178,225
Total plan assets at beginning of year2017-12-31$9,596,622
Value of fidelity bond covering the plan2017-12-31$500,000
Total contributions received or receivable from participants2017-12-31$184,292
Other income received2017-12-31$1,146,415
Net income (gross income less expenses)2017-12-31$1,581,603
Net plan assets at end of year (total assets less liabilities)2017-12-31$11,178,225
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$9,596,622
Assets. Value of assets in partnership/joint-venture interests2017-12-31$150,000
Total contributions received or receivable from employer(s)2017-12-31$381,278
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$27,451
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-12-31$1,104,346
Expenses. Total of all expenses incurred2016-12-31$224,368
Benefits paid (including direct rollovers)2016-12-31$224,368
Total plan assets at end of year2016-12-31$9,596,622
Total plan assets at beginning of year2016-12-31$8,716,644
Value of fidelity bond covering the plan2016-12-31$500,000
Total contributions received or receivable from participants2016-12-31$178,354
Other income received2016-12-31$589,979
Net income (gross income less expenses)2016-12-31$879,978
Net plan assets at end of year (total assets less liabilities)2016-12-31$9,596,622
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$8,716,644
Assets. Value of assets in partnership/joint-venture interests2016-12-31$150,000
Total contributions received or receivable from employer(s)2016-12-31$336,013
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$-284,922
Expenses. Total of all expenses incurred2015-12-31$480,451
Benefits paid (including direct rollovers)2015-12-31$480,451
Total plan assets at end of year2015-12-31$8,716,644
Total plan assets at beginning of year2015-12-31$9,482,017
Value of fidelity bond covering the plan2015-12-31$500,000
Total contributions received or receivable from participants2015-12-31$166,031
Other income received2015-12-31$-769,608
Net income (gross income less expenses)2015-12-31$-765,373
Net plan assets at end of year (total assets less liabilities)2015-12-31$8,716,644
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$9,482,017
Assets. Value of assets in partnership/joint-venture interests2015-12-31$120,000
Total contributions received or receivable from employer(s)2015-12-31$318,655
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-12-31$980,030
Expenses. Total of all expenses incurred2014-12-31$1,171,127
Benefits paid (including direct rollovers)2014-12-31$1,171,127
Total plan assets at end of year2014-12-31$9,482,017
Total plan assets at beginning of year2014-12-31$9,673,114
Value of fidelity bond covering the plan2014-12-31$500,000
Total contributions received or receivable from participants2014-12-31$184,400
Other income received2014-12-31$438,020
Net income (gross income less expenses)2014-12-31$-191,097
Net plan assets at end of year (total assets less liabilities)2014-12-31$9,482,017
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$9,673,114
Assets. Value of assets in partnership/joint-venture interests2014-12-31$120,000
Total contributions received or receivable from employer(s)2014-12-31$357,610
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-12-31$1,790,660
Expenses. Total of all expenses incurred2013-12-31$303,369
Benefits paid (including direct rollovers)2013-12-31$284,667
Total plan assets at end of year2013-12-31$9,673,114
Total plan assets at beginning of year2013-12-31$8,185,823
Total contributions received or receivable from participants2013-12-31$174,586
Assets. Value of loans (other than to participants)2013-12-31$50,000
Other income received2013-12-31$1,304,348
Net income (gross income less expenses)2013-12-31$1,487,291
Net plan assets at end of year (total assets less liabilities)2013-12-31$9,673,114
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$8,185,823
Assets. Value of assets in partnership/joint-venture interests2013-12-31$120,000
Total contributions received or receivable from employer(s)2013-12-31$311,726
Value of certain deemed distributions of participant loans2013-12-31$18,702
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0

Form 5500 Responses for UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN

2021: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: UROLOGY P. A. , SAFE-HARBOR 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: UROLOGY P. A. , SAFE-HARBOR 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: UROLOGY P. A. , SAFE-HARBOR 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: UROLOGY P. A. , SAFE-HARBOR 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 – TrustYes
2013-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number503099-01
Policy instance 1
Insurance contract or identification number503099-01
Number of Individuals Covered8
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number503099-01
Policy instance 1
Insurance contract or identification number503099-01
Number of Individuals Covered42
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,407
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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 $4,407
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerINSURANCE AGENT
Insurance broker organization code?3
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberGA-834943
Policy instance 1
Insurance contract or identification numberGA-834943
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,153
Total amount of fees paid to insurance companyUSD $1,288
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,153
Insurance broker organization code?4
Amount paid for insurance broker fees953
Additional information about fees paid to insurance brokerADMINISTRATIVE ALLOWANCE
Insurance broker nameAZALEA ADMINISTRATION, LLC
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number503099-01
Policy instance 2
Insurance contract or identification number503099-01
Number of Individuals Covered43
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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 numberGA-834943
Policy instance 1
Insurance contract or identification numberGA-834943
Number of Individuals Covered40
Insurance policy start date2016-01-01
Insurance policy end date2016-12-31
Total amount of commissions paid to insurance brokerUSD $4,922
Total amount of fees paid to insurance companyUSD $1,230
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,922
Insurance broker organization code?4
Amount paid for insurance broker fees1230
Additional information about fees paid to insurance brokerADMINISTRATIVE ALLOWANCE
Insurance broker namePENSION PARTNERS, INC.
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberGA-834943
Policy instance 1
Insurance contract or identification numberGA-834943
Number of Individuals Covered39
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,488
Total amount of fees paid to insurance companyUSD $348
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,688
Insurance broker organization code?4
Amount paid for insurance broker fees348
Additional information about fees paid to insurance brokerADMINISTRATIVE ALLOWANCE
Insurance broker namePENSION PARTNERS, INC.
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract numberGA-834943
Policy instance 1
Insurance contract or identification numberGA-834943
Number of Individuals Covered43
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $24,328
Total amount of fees paid to insurance companyUSD $7,500
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,328
Insurance broker organization code?4
Amount paid for insurance broker fees7500
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker namePENSION PARTNERS, INC.

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