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PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 401k Plan overview

Plan NamePELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN
Plan identification number 001

PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • Plan not intended to be qualified - A plan not intended to be qualified under Code sections 401, 403, or 408.

401k Sponsoring company profile

PELEGRINA MEDICAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:PELEGRINA MEDICAL, INC.
Employer identification number (EIN):660382111
NAIC Classification:621399
NAIC Description:Offices of All Other Miscellaneous Health Practitioners

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01JORGE PELEGRINA
0012016-01-01JORGE PELEGRINA
0012015-01-01JORGE PELEGRINA
0012015-01-01
0012014-01-01JORGE PELEGRINA
0012013-01-01JORGE PELEGRINA
0012012-01-01JORGE PELEGRINA
0012011-01-01JORGE PELEGRINA
0012009-01-01JORGE PELEGRINA

Plan Statistics for PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN

401k plan membership statisitcs for PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN

Measure Date Value
2022: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-018
Total number of active participants reported on line 7a of the Form 55002022-01-018
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-018
Number of participants with account balances2022-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-018
Total number of active participants reported on line 7a of the Form 55002021-01-018
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-018
Number of participants with account balances2021-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-018
Total number of active participants reported on line 7a of the Form 55002020-01-018
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-018
Number of participants with account balances2020-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-018
Total number of active participants reported on line 7a of the Form 55002019-01-017
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-018
Number of participants with account balances2019-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0110
Total number of active participants reported on line 7a of the Form 55002018-01-018
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-018
Number of participants with account balances2018-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0110
Total number of active participants reported on line 7a of the Form 55002017-01-0110
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0110
Number of participants with account balances2017-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0150
Total number of active participants reported on line 7a of the Form 55002016-01-0150
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-011
Total of all active and inactive participants2016-01-0151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0151
Number of participants with account balances2016-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0147
Total number of active participants reported on line 7a of the Form 55002015-01-0151
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0151
Number of participants with account balances2015-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0148
Total number of active participants reported on line 7a of the Form 55002014-01-0146
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0146
Number of participants with account balances2014-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0143
Total number of active participants reported on line 7a of the Form 55002013-01-0146
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-011
Total of all active and inactive participants2013-01-0147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0147
Number of participants with account balances2013-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0144
Total number of active participants reported on line 7a of the Form 55002012-01-0142
Number of retired or separated participants receiving benefits2012-01-011
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0143
Number of participants with account balances2012-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0144
Total number of active participants reported on line 7a of the Form 55002011-01-0143
Number of retired or separated participants receiving benefits2011-01-011
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0144
Number of participants with account balances2011-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0149
Total number of active participants reported on line 7a of the Form 55002009-01-0144
Number of retired or separated participants receiving benefits2009-01-011
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0145
Number of participants with account balances2009-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN

Measure Date Value
2022 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2022 401k financial data
Total plan liabilities at beginning of year2022-12-31$0
Total income from all sources2022-12-31$-48,029
Expenses. Total of all expenses incurred2022-12-31$0
Total plan assets at end of year2022-12-31$235,269
Total plan assets at beginning of year2022-12-31$283,298
Total contributions received or receivable from participants2022-12-31$14,690
Other income received2022-12-31$-62,719
Net income (gross income less expenses)2022-12-31$-48,029
Net plan assets at end of year (total assets less liabilities)2022-12-31$235,269
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$283,298
2021 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2021 401k financial data
Transfers to/from the plan2021-12-31$0
Total plan liabilities at end of year2021-12-31$0
Total plan liabilities at beginning of year2021-12-31$0
Total income from all sources2021-12-31$48,802
Expenses. Total of all expenses incurred2021-12-31$8,557
Benefits paid (including direct rollovers)2021-12-31$8,557
Total plan assets at end of year2021-12-31$283,298
Total plan assets at beginning of year2021-12-31$243,053
Total contributions received or receivable from participants2021-12-31$10,694
Expenses. Other expenses not covered elsewhere2021-12-31$0
Contributions received from other sources (not participants or employers)2021-12-31$0
Other income received2021-12-31$38,108
Noncash contributions received2021-12-31$0
Net income (gross income less expenses)2021-12-31$40,245
Net plan assets at end of year (total assets less liabilities)2021-12-31$283,298
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$243,053
Total contributions received or receivable from employer(s)2021-12-31$0
Value of certain deemed distributions of participant loans2021-12-31$0
Value of corrective distributions2021-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$0
2020 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2020 401k financial data
Transfers to/from the plan2020-12-31$0
Total plan liabilities at end of year2020-12-31$0
Total plan liabilities at beginning of year2020-12-31$0
Total income from all sources2020-12-31$66,167
Expenses. Total of all expenses incurred2020-12-31$30,000
Benefits paid (including direct rollovers)2020-12-31$30,000
Total plan assets at end of year2020-12-31$243,053
Total plan assets at beginning of year2020-12-31$206,886
Total contributions received or receivable from participants2020-12-31$12,376
Expenses. Other expenses not covered elsewhere2020-12-31$0
Contributions received from other sources (not participants or employers)2020-12-31$0
Other income received2020-12-31$53,791
Noncash contributions received2020-12-31$0
Net income (gross income less expenses)2020-12-31$36,167
Net plan assets at end of year (total assets less liabilities)2020-12-31$243,053
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$206,886
Total contributions received or receivable from employer(s)2020-12-31$0
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$0
2019 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2019 401k financial data
Transfers to/from the plan2019-12-31$0
Total plan liabilities at end of year2019-12-31$0
Total plan liabilities at beginning of year2019-12-31$0
Total income from all sources2019-12-31$73,714
Expenses. Total of all expenses incurred2019-12-31$118,252
Benefits paid (including direct rollovers)2019-12-31$118,252
Total plan assets at end of year2019-12-31$206,886
Total plan assets at beginning of year2019-12-31$251,424
Total contributions received or receivable from participants2019-12-31$13,663
Expenses. Other expenses not covered elsewhere2019-12-31$0
Contributions received from other sources (not participants or employers)2019-12-31$0
Other income received2019-12-31$60,051
Noncash contributions received2019-12-31$0
Net income (gross income less expenses)2019-12-31$-44,538
Net plan assets at end of year (total assets less liabilities)2019-12-31$206,886
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$251,424
Total contributions received or receivable from employer(s)2019-12-31$0
Value of certain deemed distributions of participant loans2019-12-31$0
Value of corrective distributions2019-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$0
2018 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2018 401k financial data
Transfers to/from the plan2018-12-31$0
Total plan liabilities at end of year2018-12-31$0
Total plan liabilities at beginning of year2018-12-31$0
Total income from all sources2018-12-31$15,168
Expenses. Total of all expenses incurred2018-12-31$13,519
Benefits paid (including direct rollovers)2018-12-31$13,519
Total plan assets at end of year2018-12-31$251,424
Total plan assets at beginning of year2018-12-31$249,775
Total contributions received or receivable from participants2018-12-31$19,059
Expenses. Other expenses not covered elsewhere2018-12-31$0
Contributions received from other sources (not participants or employers)2018-12-31$0
Other income received2018-12-31$-3,891
Noncash contributions received2018-12-31$0
Net income (gross income less expenses)2018-12-31$1,649
Net plan assets at end of year (total assets less liabilities)2018-12-31$251,424
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$249,775
Total contributions received or receivable from employer(s)2018-12-31$0
Value of certain deemed distributions of participant loans2018-12-31$0
Value of corrective distributions2018-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$0
2017 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2017 401k financial data
Transfers to/from the plan2017-12-31$0
Total plan liabilities at end of year2017-12-31$0
Total plan liabilities at beginning of year2017-12-31$0
Total income from all sources2017-12-31$54,140
Expenses. Total of all expenses incurred2017-12-31$8,140
Benefits paid (including direct rollovers)2017-12-31$8,090
Total plan assets at end of year2017-12-31$249,775
Total plan assets at beginning of year2017-12-31$203,775
Total contributions received or receivable from participants2017-12-31$17,579
Expenses. Other expenses not covered elsewhere2017-12-31$50
Contributions received from other sources (not participants or employers)2017-12-31$0
Other income received2017-12-31$36,561
Noncash contributions received2017-12-31$0
Net income (gross income less expenses)2017-12-31$46,000
Net plan assets at end of year (total assets less liabilities)2017-12-31$249,775
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$203,775
Total contributions received or receivable from employer(s)2017-12-31$0
Value of certain deemed distributions of participant loans2017-12-31$0
Value of corrective distributions2017-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$0
2016 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2016 401k financial data
Transfers to/from the plan2016-12-31$0
Total plan liabilities at end of year2016-12-31$0
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$27,077
Expenses. Total of all expenses incurred2016-12-31$7,875
Benefits paid (including direct rollovers)2016-12-31$7,800
Total plan assets at end of year2016-12-31$203,775
Total plan assets at beginning of year2016-12-31$184,573
Total contributions received or receivable from participants2016-12-31$19,552
Expenses. Other expenses not covered elsewhere2016-12-31$75
Contributions received from other sources (not participants or employers)2016-12-31$0
Other income received2016-12-31$7,525
Noncash contributions received2016-12-31$0
Net income (gross income less expenses)2016-12-31$19,202
Net plan assets at end of year (total assets less liabilities)2016-12-31$203,775
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$184,573
Total contributions received or receivable from employer(s)2016-12-31$0
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$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2015 401k financial data
Transfers to/from the plan2015-12-31$0
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$17,460
Expenses. Total of all expenses incurred2015-12-31$28,125
Benefits paid (including direct rollovers)2015-12-31$28,000
Total plan assets at end of year2015-12-31$184,573
Total plan assets at beginning of year2015-12-31$195,237
Value of fidelity bond covering the plan2015-12-31$0
Assets. Value of tangible personal property2015-12-31$0
Total contributions received or receivable from participants2015-12-31$16,399
Assets. Value of loans (other than to participants)2015-12-31$0
Expenses. Other expenses not covered elsewhere2015-12-31$125
Contributions received from other sources (not participants or employers)2015-12-31$0
Other income received2015-12-31$1,061
Noncash contributions received2015-12-31$0
Net income (gross income less expenses)2015-12-31$-10,665
Net plan assets at end of year (total assets less liabilities)2015-12-31$184,573
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$195,237
Assets. Value of participant loans2015-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2015-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2015-12-31$0
Assets. Value of assets in partnership/joint-venture interests2015-12-31$0
Assets. Value of real-estate (other than employer real property)2015-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022015-12-31$0
Assets. Value of employer securities2015-12-31$0
Assets. Value of employer real property2015-12-31$0
Total contributions received or receivable from employer(s)2015-12-31$0
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$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$30,670
Expenses. Total of all expenses incurred2014-12-31$41,069
Benefits paid (including direct rollovers)2014-12-31$40,969
Total plan assets at end of year2014-12-31$195,237
Total plan assets at beginning of year2014-12-31$205,636
Value of fidelity bond covering the plan2014-12-31$0
Assets. Value of tangible personal property2014-12-31$0
Total contributions received or receivable from participants2014-12-31$0
Assets. Value of loans (other than to participants)2014-12-31$0
Expenses. Other expenses not covered elsewhere2014-12-31$100
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$10,858
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$-10,399
Net plan assets at end of year (total assets less liabilities)2014-12-31$195,237
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$205,636
Assets. Value of participant loans2014-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2014-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2014-12-31$0
Assets. Value of assets in partnership/joint-venture interests2014-12-31$0
Assets. Value of real-estate (other than employer real property)2014-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022014-12-31$0
Assets. Value of employer securities2014-12-31$0
Assets. Value of employer real property2014-12-31$0
Total contributions received or receivable from employer(s)2014-12-31$19,812
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$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$49,666
Expenses. Total of all expenses incurred2013-12-31$14,323
Benefits paid (including direct rollovers)2013-12-31$14,248
Total plan assets at end of year2013-12-31$205,636
Total plan assets at beginning of year2013-12-31$170,293
Value of fidelity bond covering the plan2013-12-31$0
Assets. Value of tangible personal property2013-12-31$0
Total contributions received or receivable from participants2013-12-31$0
Assets. Value of loans (other than to participants)2013-12-31$0
Expenses. Other expenses not covered elsewhere2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$34,581
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$35,343
Net plan assets at end of year (total assets less liabilities)2013-12-31$205,636
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$170,293
Assets. Value of participant loans2013-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2013-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2013-12-31$0
Assets. Value of assets in partnership/joint-venture interests2013-12-31$0
Assets. Value of real-estate (other than employer real property)2013-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022013-12-31$0
Assets. Value of employer securities2013-12-31$0
Assets. Value of employer real property2013-12-31$0
Total contributions received or receivable from employer(s)2013-12-31$15,085
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$75
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2013-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$0
Total income from all sources2012-12-31$31,204
Expenses. Total of all expenses incurred2012-12-31$0
Benefits paid (including direct rollovers)2012-12-31$0
Total plan assets at end of year2012-12-31$170,293
Total plan assets at beginning of year2012-12-31$139,089
Value of fidelity bond covering the plan2012-12-31$0
Assets. Value of tangible personal property2012-12-31$0
Total contributions received or receivable from participants2012-12-31$16,238
Assets. Value of loans (other than to participants)2012-12-31$0
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$14,966
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$31,204
Net plan assets at end of year (total assets less liabilities)2012-12-31$170,293
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$139,089
Assets. Value of participant loans2012-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2012-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2012-12-31$0
Assets. Value of assets in partnership/joint-venture interests2012-12-31$0
Assets. Value of real-estate (other than employer real property)2012-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022012-12-31$0
Assets. Value of employer securities2012-12-31$0
Assets. Value of employer real property2012-12-31$0
Total contributions received or receivable from employer(s)2012-12-31$0
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$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2012-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$17,273
Expenses. Total of all expenses incurred2011-12-31$29,447
Benefits paid (including direct rollovers)2011-12-31$29,397
Total plan assets at end of year2011-12-31$139,089
Total plan assets at beginning of year2011-12-31$151,263
Value of fidelity bond covering the plan2011-12-31$0
Assets. Value of tangible personal property2011-12-31$0
Total contributions received or receivable from participants2011-12-31$13,695
Assets. Value of loans (other than to participants)2011-12-31$0
Expenses. Other expenses not covered elsewhere2011-12-31$50
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-1,006
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$-12,174
Net plan assets at end of year (total assets less liabilities)2011-12-31$139,089
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$151,263
Assets. Value of participant loans2011-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2011-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2011-12-31$0
Assets. Value of assets in partnership/joint-venture interests2011-12-31$0
Assets. Value of real-estate (other than employer real property)2011-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022011-12-31$0
Assets. Value of employer securities2011-12-31$0
Assets. Value of employer real property2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$4,584
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$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2011-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$30,365
Expenses. Total of all expenses incurred2010-12-31$1,321
Benefits paid (including direct rollovers)2010-12-31$1,296
Total plan assets at end of year2010-12-31$151,263
Total plan assets at beginning of year2010-12-31$122,219
Value of fidelity bond covering the plan2010-12-31$0
Assets. Value of tangible personal property2010-12-31$0
Total contributions received or receivable from participants2010-12-31$17,051
Assets. Value of loans (other than to participants)2010-12-31$0
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$13,314
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$29,044
Net plan assets at end of year (total assets less liabilities)2010-12-31$151,263
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$122,219
Assets. Value of participant loans2010-12-31$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2010-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2010-12-31$0
Assets. Value of assets in partnership/joint-venture interests2010-12-31$0
Assets. Value of real-estate (other than employer real property)2010-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022010-12-31$0
Assets. Value of employer securities2010-12-31$0
Assets. Value of employer real property2010-12-31$0
Total contributions received or receivable from employer(s)2010-12-31$0
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$25
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2010-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2009 401k financial data
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2009-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0
Funding deficiency by the employer to the plan for this plan year2009-12-31$0
Minimum employer required contribution for this plan year2009-12-31$0
Amount contributed by the employer to the plan for this plan year2009-12-31$0

Form 5500 Responses for PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN

2022: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT 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: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT 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: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT 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 - TrustYes
2018: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT 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 – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT 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 – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT 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 – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedYes
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 – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT 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 – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT 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
2012: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT 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 – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT 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 – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: PELEGRINA MEDICAL, INC. EMPLOYEE RETIREMENT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number664397
Policy instance 1
Insurance contract or identification number664397
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number664397
Policy instance 1
Insurance contract or identification number664397
Number of Individuals Covered0
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number664397
Policy instance 1
Insurance contract or identification number664397
Number of Individuals Covered0
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number664397
Policy instance 1
Insurance contract or identification number664397
Number of Individuals Covered0
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number664397
Policy instance 1
Insurance contract or identification number664397
Number of Individuals Covered10
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $50
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees50
Insurance broker organization code?3
Insurance broker nameRAFAEL BAERGA
ING LIFE INSRUANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberCONTRACT NUMBER
Policy instance 1
Insurance contract or identification numberCONTRACT NUMBER
Number of Individuals Covered0
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?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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameRAFAEL BAERGA
ING LIFE INSRUANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberCONTRACT NUMBER
Policy instance 1
Insurance contract or identification numberCONTRACT NUMBER
Number of Individuals Covered0
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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?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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees500
Insurance broker organization code?3
Insurance broker nameRAFAEL BAERGA
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number664397
Policy instance 1
Insurance contract or identification number664397
Number of Individuals Covered0
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $384
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?Yes
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees384
Insurance broker organization code?3
Insurance broker nameRAFAEL BAERGA-VAQUER
ING LIFE INSRUANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number664397
Policy instance 1
Insurance contract or identification number664397
Number of Individuals Covered0
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $358
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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