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PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 401k Plan overview

Plan NamePUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN
Plan identification number 001

PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND 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.
  • 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

PUTNAM NORTH FAMILY MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name:PUTNAM NORTH FAMILY MEDICAL CENTER
Employer identification number (EIN):731439658
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012017-01-01
0012017-01-01
0012016-01-01
0012015-01-01JOHN R. PITTMAN
0012014-01-01JOHN R. PITTMAN
0012013-01-01
0012012-01-01JOHN R. PITTMAN JOHN R. PITTMAN2013-10-11
0012011-01-01JOHN R. PITTMAN JOHN R. PITTMAN2012-10-12
0012010-01-01JOHN R. PITTMAN JOHN R. PITTMAN2011-10-13
0012009-01-01JOHN R. PITTMAN

Plan Statistics for PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN

401k plan membership statisitcs for PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN

Measure Date Value
2017: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2017 401k membership
Total of all active and inactive participants2017-01-010
Total participants2017-01-010
Total participants, beginning-of-year2017-01-0119
Total number of active participants reported on line 7a of the Form 55002017-01-010
2016: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0119
Total number of active participants reported on line 7a of the Form 55002016-01-0119
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0119
Number of participants with account balances2016-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0119
Total number of active participants reported on line 7a of the Form 55002015-01-0119
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 participants2015-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0119
Number of participants with account balances2015-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0121
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0119
Total of all active and inactive participants2014-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0119
Number of participants with account balances2014-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0118
Total number of active participants reported on line 7a of the Form 55002013-01-0124
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0124
Number of participants with account balances2013-01-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0115
Total number of active participants reported on line 7a of the Form 55002012-01-0118
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0118
Number of participants with account balances2012-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0116
Total number of active participants reported on line 7a of the Form 55002011-01-0117
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-011
Total of all active and inactive participants2011-01-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0118
Number of participants with account balances2011-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0116
Total number of active participants reported on line 7a of the Form 55002010-01-0112
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-014
Total of all active and inactive participants2010-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0116
Number of participants with account balances2010-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-011
2009: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0118
Total number of active participants reported on line 7a of the Form 55002009-01-0120
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-011
Total of all active and inactive participants2009-01-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0121
Number of participants with account balances2009-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN

Measure Date Value
2017 : PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources2017-12-31$0
Expenses. Total of all expenses incurred2017-12-31$0
Benefits paid (including direct rollovers)2017-12-31$693,426
Total plan assets at end of year2017-12-31$0
Total plan assets at beginning of year2017-12-31$693,426
Value of fidelity bond covering the plan2017-12-31$66,000
Net income (gross income less expenses)2017-12-31$0
Net plan assets at end of year (total assets less liabilities)2017-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$693,426
2016 : PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-12-31$71,699
Expenses. Total of all expenses incurred2016-12-31$6,512
Total plan assets at end of year2016-12-31$693,426
Total plan assets at beginning of year2016-12-31$628,239
Value of fidelity bond covering the plan2016-12-31$66,000
Other income received2016-12-31$71,699
Net income (gross income less expenses)2016-12-31$65,187
Net plan assets at end of year (total assets less liabilities)2016-12-31$693,426
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$628,239
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$6,512
2015 : PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$-24,489
Expenses. Total of all expenses incurred2015-12-31$6,605
Total plan assets at end of year2015-12-31$628,239
Total plan assets at beginning of year2015-12-31$659,333
Value of fidelity bond covering the plan2015-12-31$66,000
Other income received2015-12-31$-24,489
Net income (gross income less expenses)2015-12-31$-31,094
Net plan assets at end of year (total assets less liabilities)2015-12-31$628,239
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$659,333
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$6,605
2014 : PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at beginning of year2014-12-31$136
Total income from all sources2014-12-31$23,017
Expenses. Total of all expenses incurred2014-12-31$26,132
Benefits paid (including direct rollovers)2014-12-31$19,282
Total plan assets at end of year2014-12-31$659,333
Total plan assets at beginning of year2014-12-31$662,584
Value of fidelity bond covering the plan2014-12-31$66,000
Other income received2014-12-31$23,017
Net income (gross income less expenses)2014-12-31$-3,115
Net plan assets at end of year (total assets less liabilities)2014-12-31$659,333
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$662,448
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$6,850
2013 : PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at end of year2013-12-31$136
Total plan liabilities at beginning of year2013-12-31$820
Total income from all sources2013-12-31$165,522
Expenses. Total of all expenses incurred2013-12-31$6,668
Benefits paid (including direct rollovers)2013-12-31$483
Total plan assets at end of year2013-12-31$662,584
Total plan assets at beginning of year2013-12-31$504,414
Total contributions received or receivable from participants2013-12-31$17,127
Other income received2013-12-31$141,273
Net income (gross income less expenses)2013-12-31$158,854
Net plan assets at end of year (total assets less liabilities)2013-12-31$662,448
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$503,594
Total contributions received or receivable from employer(s)2013-12-31$7,122
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$6,185
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at end of year2012-12-31$820
Total plan liabilities at beginning of year2012-12-31$1,603
Total income from all sources2012-12-31$104,633
Expenses. Total of all expenses incurred2012-12-31$52,533
Benefits paid (including direct rollovers)2012-12-31$47,151
Total plan assets at end of year2012-12-31$504,414
Total plan assets at beginning of year2012-12-31$453,097
Total contributions received or receivable from participants2012-12-31$16,539
Contributions received from other sources (not participants or employers)2012-12-31$13,771
Other income received2012-12-31$66,460
Net income (gross income less expenses)2012-12-31$52,100
Net plan assets at end of year (total assets less liabilities)2012-12-31$503,594
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$451,494
Assets. Value of participant loans2012-12-31$5,182
Total contributions received or receivable from employer(s)2012-12-31$7,863
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$5,382
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2011 401k financial data
Total plan liabilities at end of year2011-12-31$1,603
Total plan liabilities at beginning of year2011-12-31$952
Total income from all sources2011-12-31$-9,675
Expenses. Total of all expenses incurred2011-12-31$4,832
Benefits paid (including direct rollovers)2011-12-31$4,832
Total plan assets at end of year2011-12-31$453,097
Total plan assets at beginning of year2011-12-31$466,953
Total contributions received or receivable from participants2011-12-31$26,022
Other income received2011-12-31$-47,985
Net income (gross income less expenses)2011-12-31$-14,507
Net plan assets at end of year (total assets less liabilities)2011-12-31$451,494
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$466,001
Total contributions received or receivable from employer(s)2011-12-31$12,288
2010 : PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at end of year2010-12-31$952
Total plan liabilities at beginning of year2010-12-31$815
Total income from all sources2010-12-31$124,976
Expenses. Total of all expenses incurred2010-12-31$53,899
Benefits paid (including direct rollovers)2010-12-31$53,899
Total plan assets at end of year2010-12-31$466,953
Total plan assets at beginning of year2010-12-31$395,739
Total contributions received or receivable from participants2010-12-31$46,692
Other income received2010-12-31$61,612
Net income (gross income less expenses)2010-12-31$71,077
Net plan assets at end of year (total assets less liabilities)2010-12-31$466,001
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$394,924
Total contributions received or receivable from employer(s)2010-12-31$16,672
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN

2017: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND 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: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND 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: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND 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: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND 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: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: PUTNAM NORTH FAMILY MEDICAL CENTER 401(K) AND PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number91652989
Policy instance 1
Insurance contract or identification number91652989
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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?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
Insurance broker organization code?3
Insurance broker nameKEVIN P. SCHWARZ
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number91652989
Policy instance 1
Insurance contract or identification number91652989
Number of Individuals Covered19
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,981
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?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
Commission paid to Insurance BrokerUSD $1,981
Insurance broker organization code?3
Insurance broker nameDARREN TELFORD
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number91652989
Policy instance 1
Insurance contract or identification number91652989
Number of Individuals Covered19
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,981
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?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
Commission paid to Insurance BrokerUSD $1,981
Insurance broker organization code?3
Insurance broker nameDARREN TELFORD
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number91652989
Policy instance 1
Insurance contract or identification number91652989
Number of Individuals Covered22
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,850
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?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
Commission paid to Insurance BrokerUSD $1,850
Insurance broker organization code?3
Insurance broker nameDARREN TELFORD
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number91652989
Policy instance 1
Insurance contract or identification number91652989
Number of Individuals Covered1484
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,416
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?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
Commission paid to Insurance BrokerUSD $1,416
Insurance broker organization code?3
Insurance broker nameDARREN TELFORD
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number91652989
Policy instance 1
Insurance contract or identification number91652989
Number of Individuals Covered15
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,416
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?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
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number91652989
Policy instance 1
Insurance contract or identification number91652989
Number of Individuals Covered16
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $915
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?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
Commission paid to Insurance BrokerUSD $915
Insurance broker organization code?3
Insurance broker nameDARREN TELFORD

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