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CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameCENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN
Plan identification number 001

CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

CENTRAL COAST FAMILY CARE MEDICAL ASSOCIATES OF SANTA MARIA, INC. has sponsored the creation of one or more 401k plans.

Company Name:CENTRAL COAST FAMILY CARE MEDICAL ASSOCIATES OF SANTA MARIA, INC.
Employer identification number (EIN):770404320
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01SUE PERRY2023-05-26
0012021-01-01SUE PERRY2022-09-22
0012020-01-01LAURA THEIS2021-08-09
0012019-01-01LAURA THEIS2020-07-15
0012018-01-01LAURA THEIS2019-10-11 LAURA THEIS2019-10-11
0012018-01-01JULEEN STIMSON2019-10-11
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01
0012013-01-01MICHAEL P. SCHRAGER, M.D.
0012012-01-01MICHAEL P. SCHRAGER, M.D.
0012011-01-01MICHAEL P. SCHRAGER, M.D.
0012009-01-01DOUGLAS S. HENDRY

Plan Statistics for CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN

Measure Date Value
2014: CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0154
Total number of active participants reported on line 7a of the Form 55002014-01-0148
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-016
Total of all active and inactive participants2014-01-0154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0154
Number of participants with account balances2014-01-0154
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-014
2013: CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0149
Total number of active participants reported on line 7a of the Form 55002013-01-0147
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-017
Total of all active and inactive participants2013-01-0154
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0154
Number of participants with account balances2013-01-0154
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-015
2012: CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0153
Total number of active participants reported on line 7a of the Form 55002012-01-0146
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-013
Total of all active and inactive participants2012-01-0149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0149
Number of participants with account balances2012-01-0149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-013
2011: CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0155
Total number of active participants reported on line 7a of the Form 55002011-01-0143
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0110
Total of all active and inactive participants2011-01-0153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0153
Number of participants with account balances2011-01-0153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-019
2009: CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0161
Total number of active participants reported on line 7a of the Form 55002009-01-0145
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-018
Total of all active and inactive participants2009-01-0153
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0153
Number of participants with account balances2009-01-0153
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-015

Financial Data on CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN

Measure Date Value
2014 : CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at end of year2014-12-31$11,099
Total plan liabilities at beginning of year2014-12-31$12,609
Total income from all sources2014-12-31$867,627
Expenses. Total of all expenses incurred2014-12-31$363,304
Benefits paid (including direct rollovers)2014-12-31$355,590
Total plan assets at end of year2014-12-31$7,114,343
Total plan assets at beginning of year2014-12-31$6,611,530
Value of fidelity bond covering the plan2014-12-31$500,000
Total contributions received or receivable from participants2014-12-31$230,522
Expenses. Other expenses not covered elsewhere2014-12-31$7,714
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$303,210
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$504,323
Net plan assets at end of year (total assets less liabilities)2014-12-31$7,103,244
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$6,598,921
Total contributions received or receivable from employer(s)2014-12-31$333,895
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 : CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total plan liabilities at end of year2013-12-31$12,609
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$1,195,351
Expenses. Total of all expenses incurred2013-12-31$598,987
Benefits paid (including direct rollovers)2013-12-31$588,227
Total plan assets at end of year2013-12-31$6,611,530
Total plan assets at beginning of year2013-12-31$6,002,557
Value of fidelity bond covering the plan2013-12-31$500,000
Total contributions received or receivable from participants2013-12-31$227,649
Expenses. Other expenses not covered elsewhere2013-12-31$10,760
Contributions received from other sources (not participants or employers)2013-12-31$17
Other income received2013-12-31$655,669
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$596,364
Net plan assets at end of year (total assets less liabilities)2013-12-31$6,598,921
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$6,002,557
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$8,264
Total contributions received or receivable from employer(s)2013-12-31$312,016
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$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$500
Total income from all sources2012-12-31$1,238,933
Expenses. Total of all expenses incurred2012-12-31$2,289,120
Benefits paid (including direct rollovers)2012-12-31$2,276,415
Total plan assets at end of year2012-12-31$6,002,557
Total plan assets at beginning of year2012-12-31$7,053,244
Value of fidelity bond covering the plan2012-12-31$5,000,000
Total contributions received or receivable from participants2012-12-31$269,970
Expenses. Other expenses not covered elsewhere2012-12-31$12,570
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$618,639
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$-1,050,187
Net plan assets at end of year (total assets less liabilities)2012-12-31$6,002,557
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$7,052,744
Total contributions received or receivable from employer(s)2012-12-31$350,324
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$135
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total plan liabilities at end of year2011-12-31$500
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$493,897
Expenses. Total of all expenses incurred2011-12-31$232,895
Benefits paid (including direct rollovers)2011-12-31$209,165
Total plan assets at end of year2011-12-31$7,053,244
Total plan assets at beginning of year2011-12-31$6,791,742
Value of fidelity bond covering the plan2011-12-31$5,000,000
Total contributions received or receivable from participants2011-12-31$235,366
Expenses. Other expenses not covered elsewhere2011-12-31$23,730
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-65,347
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$261,002
Net plan assets at end of year (total assets less liabilities)2011-12-31$7,052,744
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$6,791,742
Total contributions received or receivable from employer(s)2011-12-31$323,878
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING 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$5,740
Total income from all sources2010-12-31$1,177,977
Expenses. Total of all expenses incurred2010-12-31$166,563
Benefits paid (including direct rollovers)2010-12-31$161,895
Total plan assets at end of year2010-12-31$6,791,742
Total plan assets at beginning of year2010-12-31$5,786,068
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$242,732
Expenses. Other expenses not covered elsewhere2010-12-31$4,668
Contributions received from other sources (not participants or employers)2010-12-31$129,513
Other income received2010-12-31$493,394
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$1,011,414
Net plan assets at end of year (total assets less liabilities)2010-12-31$6,791,742
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$5,780,328
Assets. Value of assets in partnership/joint-venture interests2010-12-31$93,003
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$6,720
Total contributions received or receivable from employer(s)2010-12-31$312,338
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$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : CENTRAL COAST FAMILY CARE 401(K) 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 CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN

2014: CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
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: CENTRAL COAST FAMILY CARE 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: CENTRAL COAST FAMILY CARE 401(K) 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: CENTRAL COAST FAMILY CARE 401(K) 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
2009: CENTRAL COAST FAMILY CARE 401(K) 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 number308 814 373
Policy instance 2
Insurance contract or identification number308 814 373
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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
Insurance broker organization code?3
Insurance broker nameKURT C. JACKSON, PRES, CCWM LLC.
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number800204-000
Policy instance 1
Insurance contract or identification number800204-000
Number of Individuals Covered54
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $10,836
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Commission paid to Insurance BrokerUSD $10,836
Insurance broker organization code?3
Insurance broker nameNFP INSURANCE AGENCY SERVICES
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number800204-000
Policy instance 1
Insurance contract or identification number800204-000
Number of Individuals Covered54
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $9,150
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?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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,150
Insurance broker organization code?3
Insurance broker nameNFP INSURANCE AGENCY SERVICES
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number308 814 373
Policy instance 2
Insurance contract or identification number308 814 373
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameKURT C. JACKSON, PRES, CCWM LLC.
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number800204-000
Policy instance 1
Insurance contract or identification number800204-000
Number of Individuals Covered49
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $8,675
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?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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,952
Insurance broker organization code?3
Insurance broker nameNFP INSRUANCE AGENCY SERVICES
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number308 814 373
Policy instance 2
Insurance contract or identification number308 814 373
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameKURT C. JACKSON, PRES, CCWM LLC.
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number800204-000
Policy instance 1
Insurance contract or identification number800204-000
Number of Individuals Covered53
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $7,234
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?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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number308 814 373
Policy instance 2
Insurance contract or identification number308 814 373
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number800204-000
Policy instance 1
Insurance contract or identification number800204-000
Number of Individuals Covered48
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,936
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?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
Commission paid to Insurance BrokerUSD $4,936
Insurance broker organization code?3
Insurance broker nameNFP INSURANCE AGENCY SERVICES
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number308 814 373
Policy instance 2
Insurance contract or identification number308 814 373
Number of Individuals Covered177
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,779
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 $1,779
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameKURT C. JACKSON, PRES, CCWM LLC.

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