401k Plan data: SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN plan

SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 401k Plan overview

Plan Name	SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN
Plan identification number	001

SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

SUMMIT EMERGENCY PHYSICIANS has sponsored the creation of one or more 401k plans.

Company Name: SUMMIT EMERGENCY PHYSICIANS

Employer identification number (EIN): 710863828

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

Additional information about SUMMIT EMERGENCY PHYSICIANS

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 104056

More information about SUMMIT EMERGENCY PHYSICIANS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01 JAMES KARVELAS 2022-06-16
001 2020-01-01
001 2019-01-01
001 2018-01-01 JAMES KARVELAS
001 2018-01-01
001 2017-01-01 JAMES KARVELAS 2018-07-30
001 2016-01-01 JAMES KARVELAS 2017-10-10
001 2015-01-01
001 2014-01-01 JIMMY KARVELAS 2015-05-29
001 2013-11-01 JIMMY KARVELAS 2014-04-03

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2021-01-01	JAMES KARVELAS	2022-06-16
001	2020-01-01
001	2019-01-01
001	2018-01-01	JAMES KARVELAS
001	2018-01-01
001	2017-01-01	JAMES KARVELAS	2018-07-30
001	2016-01-01	JAMES KARVELAS	2017-10-10
001	2015-01-01
001	2014-01-01	JIMMY KARVELAS	2015-05-29
001	2013-11-01	JIMMY KARVELAS	2014-04-03

Plan Statistics for SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN

401k plan membership statisitcs for SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN

Measure Date Value
2020: SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 1
Number of retired or separated participants receiving benefits 2020-01-01 4
Number of other retired or separated participants entitled to future benefits 2020-01-01 28
Total of all active and inactive participants 2020-01-01 33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 33
Number of participants with account balances 2020-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 166
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 9
Total of all active and inactive participants 2019-01-01 175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 175
Number of participants with account balances 2019-01-01 39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 127
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 124
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 6
Total of all active and inactive participants 2018-01-01 130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 130
Number of participants with account balances 2018-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0

Measure	Date	Value
2020: SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	1
Number of retired or separated participants receiving benefits	2020-01-01	4
Number of other retired or separated participants entitled to future benefits	2020-01-01	28
Total of all active and inactive participants	2020-01-01	33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	33
Number of participants with account balances	2020-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	166
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	9
Total of all active and inactive participants	2019-01-01	175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	175
Number of participants with account balances	2019-01-01	39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	127
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	124
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	6
Total of all active and inactive participants	2018-01-01	130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	130
Number of participants with account balances	2018-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0

Financial Data on SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN

Measure	Date	Value
2020 : SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$419,737
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$248,326
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$245,224
Value of total corrective distributions	2020-12-31	$1,134
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$294,489
Value of total assets at end of year	2020-12-31	$957,444
Value of total assets at beginning of year	2020-12-31	$786,033
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$1,968
Total interest from all sources	2020-12-31	$119
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$0
Administrative expenses professional fees incurred	2020-12-31	$1,968
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$5,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$232,302
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$62,187
Other income not declared elsewhere	2020-12-31	$1
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$171,411
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$957,444
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$786,033
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in pooled separate accounts at end of year	2020-12-31	$957,444
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$786,033
Interest on participant loans	2020-12-31	$119
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$125,128
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$245,224
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	THE AMERICAN AUDITORS GROUP, LLC
Accountancy firm EIN	2020-12-31	814229648
2019 : SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$340,158
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$152,716
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$146,876
Value of total corrective distributions	2019-12-31	$5,455
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$213,148
Value of total assets at end of year	2019-12-31	$786,033
Value of total assets at beginning of year	2019-12-31	$598,591
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$385
Total interest from all sources	2019-12-31	$2,455
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Administrative expenses professional fees incurred	2019-12-31	$385
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$5,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$206,686
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$937
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$6,462
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$187,442
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$786,033
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$598,591
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in pooled separate accounts at end of year	2019-12-31	$786,033
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$597,654
Interest on participant loans	2019-12-31	$2,455
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$124,555
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$146,876
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	THE AMERICAN AUDITORS GROUP, LLC
Accountancy firm EIN	2019-12-31	814229648
2018 : SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$317,249
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$10,107
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,887
Value of total corrective distributions	2018-12-31	$8,053
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$394,872
Value of total assets at end of year	2018-12-31	$598,591
Value of total assets at beginning of year	2018-12-31	$291,449
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$167
Total interest from all sources	2018-12-31	$116
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Administrative expenses professional fees incurred	2018-12-31	$167
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$29,150
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$208,466
Participant contributions at end of year	2018-12-31	$937
Participant contributions at beginning of year	2018-12-31	$2,513
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$186,406
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$307,142
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$598,591
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$291,449
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in pooled separate accounts at end of year	2018-12-31	$597,654
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$288,936
Interest on participant loans	2018-12-31	$116
Net investment gain/loss from pooled separate accounts	2018-12-31	$-77,739
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$1,887
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	No
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	THE AMERICAN AUDITORS GROUP, LLC
Accountancy firm EIN	2018-12-31	814229648

Form 5500 Responses for SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN

2020: SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: SUMMIT EMERGENCY PHYSICIANS,INC. 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	Yes
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-833650

Policy instance

Insurance contract or identification number	GA-833650
Number of Individuals Covered	32
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $348
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	348
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	5

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

Policy contract number

GA-833650

Policy instance

Insurance contract or identification number	GA-833650
Number of Individuals Covered	38
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $295
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	295
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	5

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

Policy contract number

GA-833650

Policy instance

Insurance contract or identification number	GA-833650
Number of Individuals Covered	31
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $160
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	160
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	5

Potentially related plans

SUMMIT EMERGENCY MEDICINE STAFFING 401(K) PLAN [EIN = 472934890]

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Company Name:	SUMMIT EMERGENCY PHYSICIANS
Employer identification number (EIN):	710863828
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	104056