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ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 401k Plan overview

Plan NameANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN
Plan identification number 003

ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. 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.
  • 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

ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C, has sponsored the creation of one or more 401k plans.

Company Name:ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C,
Employer identification number (EIN):810406760
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032018-01-01
0032017-01-01BRIAN NIMER BRIAN NIMER2018-10-09
0032016-01-01BRIAN NIMER BRIAN NIMER2017-10-11
0032015-01-01BRIAN NIMER BRIAN NIMER2016-10-13
0032014-01-01BRIAN NIMER BRIAN NIMER2015-10-12
0032013-01-01BRIAN NIMER BRIAN NIMER2014-10-11
0032012-01-01BRIAN NIMER BRIAN NIMER2013-10-03
0032011-01-01BRIAN NIMER
0032009-01-01BRIAN NIMER BRIAN NIMER2010-10-13
0032009-01-01BRIAN R. NIMER BRIAN R. NIMER2010-10-12

Plan Statistics for ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN

401k plan membership statisitcs for ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN

Measure Date Value
2018: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-018
Total number of active participants reported on line 7a of the Form 55002018-01-010
Total of all active and inactive participants2018-01-010
Total participants2018-01-010
Number of participants with account balances2018-01-010
2017: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0140
Total number of active participants reported on line 7a of the Form 55002017-01-010
Total of all active and inactive participants2017-01-010
Total participants2017-01-010
Number of participants with account balances2017-01-018
2016: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0141
Total number of active participants reported on line 7a of the Form 55002016-01-0140
Total of all active and inactive participants2016-01-0140
Total participants2016-01-0140
Number of participants with account balances2016-01-0140
2015: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0141
Total number of active participants reported on line 7a of the Form 55002015-01-0141
Total of all active and inactive participants2015-01-0141
Total participants2015-01-0141
Number of participants with account balances2015-01-0141
2014: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0139
Total number of active participants reported on line 7a of the Form 55002014-01-0141
Total of all active and inactive participants2014-01-0141
Total participants2014-01-0141
Number of participants with account balances2014-01-0141
2013: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0137
Total number of active participants reported on line 7a of the Form 55002013-01-0139
Total of all active and inactive participants2013-01-0139
Total participants2013-01-0139
Number of participants with account balances2013-01-0139
2012: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0137
Total number of active participants reported on line 7a of the Form 55002012-01-0137
Total of all active and inactive participants2012-01-0137
Total participants2012-01-0137
Number of participants with account balances2012-01-0137
2011: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0136
Total number of active participants reported on line 7a of the Form 55002011-01-0137
Total of all active and inactive participants2011-01-0137
Total participants2011-01-0137
Number of participants with account balances2011-01-0137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0135
Total number of active participants reported on line 7a of the Form 55002009-01-0137
Number of retired or separated participants receiving benefits2009-01-013
Total of all active and inactive participants2009-01-0140
Total participants2009-01-0140
Number of participants with account balances2009-01-0136

Financial Data on ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN

Measure Date Value
2018 : ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources2018-12-31$32,986
Expenses. Total of all expenses incurred2018-12-31$2,670,694
Benefits paid (including direct rollovers)2018-12-31$2,670,694
Total plan assets at end of year2018-12-31$0
Total plan assets at beginning of year2018-12-31$2,637,708
Value of fidelity bond covering the plan2018-12-31$500,000
Other income received2018-12-31$32,986
Net income (gross income less expenses)2018-12-31$-2,637,708
Net plan assets at end of year (total assets less liabilities)2018-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$2,637,708
2017 : ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources2017-12-31$2,425,821
Expenses. Total of all expenses incurred2017-12-31$18,524,289
Benefits paid (including direct rollovers)2017-12-31$18,524,289
Total plan assets at end of year2017-12-31$2,637,708
Total plan assets at beginning of year2017-12-31$18,736,176
Value of fidelity bond covering the plan2017-12-31$500,000
Total contributions received or receivable from participants2017-12-31$16,000
Other income received2017-12-31$2,294,494
Net income (gross income less expenses)2017-12-31$-16,098,468
Net plan assets at end of year (total assets less liabilities)2017-12-31$2,637,708
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$18,736,176
Total contributions received or receivable from employer(s)2017-12-31$115,327
2016 : ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-12-31$3,009,807
Expenses. Total of all expenses incurred2016-12-31$3,055,512
Benefits paid (including direct rollovers)2016-12-31$2,999,821
Total plan assets at end of year2016-12-31$18,736,176
Total plan assets at beginning of year2016-12-31$18,781,881
Value of fidelity bond covering the plan2016-12-31$500,000
Total contributions received or receivable from participants2016-12-31$496,800
Expenses. Other expenses not covered elsewhere2016-12-31$55,691
Other income received2016-12-31$1,284,417
Net income (gross income less expenses)2016-12-31$-45,705
Net plan assets at end of year (total assets less liabilities)2016-12-31$18,736,176
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$18,781,881
Assets. Value of participant loans2016-12-31$32,356
Total contributions received or receivable from employer(s)2016-12-31$1,228,590
2015 : ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$1,702,205
Expenses. Total of all expenses incurred2015-12-31$959,305
Benefits paid (including direct rollovers)2015-12-31$88,128
Total plan assets at end of year2015-12-31$18,781,881
Total plan assets at beginning of year2015-12-31$18,038,981
Value of fidelity bond covering the plan2015-12-31$500,000
Total contributions received or receivable from participants2015-12-31$509,760
Expenses. Other expenses not covered elsewhere2015-12-31$871,177
Net income (gross income less expenses)2015-12-31$742,900
Net plan assets at end of year (total assets less liabilities)2015-12-31$18,781,881
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$18,038,981
Assets. Value of participant loans2015-12-31$75,992
Total contributions received or receivable from employer(s)2015-12-31$1,192,445
2014 : ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-12-31$1,806,292
Expenses. Total of all expenses incurred2014-12-31$1,901,105
Benefits paid (including direct rollovers)2014-12-31$1,901,105
Total plan assets at end of year2014-12-31$18,038,981
Total plan assets at beginning of year2014-12-31$18,133,794
Value of fidelity bond covering the plan2014-12-31$500,000
Total contributions received or receivable from participants2014-12-31$479,500
Other income received2014-12-31$198,410
Net income (gross income less expenses)2014-12-31$-94,813
Net plan assets at end of year (total assets less liabilities)2014-12-31$18,038,981
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$18,133,794
Assets. Value of real-estate (other than employer real property)2014-12-31$260,736
Total contributions received or receivable from employer(s)2014-12-31$1,128,382
2013 : ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-12-31$2,942,406
Expenses. Total of all expenses incurred2013-12-31$702,442
Benefits paid (including direct rollovers)2013-12-31$702,442
Total plan assets at end of year2013-12-31$18,133,794
Total plan assets at beginning of year2013-12-31$15,893,830
Value of fidelity bond covering the plan2013-12-31$500,000
Total contributions received or receivable from participants2013-12-31$423,362
Other income received2013-12-31$1,443,756
Net income (gross income less expenses)2013-12-31$2,239,964
Net plan assets at end of year (total assets less liabilities)2013-12-31$18,133,794
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$15,893,830
Assets. Value of real-estate (other than employer real property)2013-12-31$275,004
Total contributions received or receivable from employer(s)2013-12-31$1,075,288
2012 : ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-12-31$2,507,058
Expenses. Total of all expenses incurred2012-12-31$831,555
Benefits paid (including direct rollovers)2012-12-31$831,555
Total plan assets at end of year2012-12-31$15,893,830
Total plan assets at beginning of year2012-12-31$14,218,327
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$427,500
Other income received2012-12-31$1,034,150
Net income (gross income less expenses)2012-12-31$1,675,503
Net plan assets at end of year (total assets less liabilities)2012-12-31$15,893,830
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$14,218,327
Assets. Value of assets in partnership/joint-venture interests2012-12-31$22,450
Assets. Value of real-estate (other than employer real property)2012-12-31$272,626
Total contributions received or receivable from employer(s)2012-12-31$1,045,408
2011 : ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$748,057
Expenses. Total of all expenses incurred2011-12-31$365,520
Benefits paid (including direct rollovers)2011-12-31$365,520
Total plan assets at end of year2011-12-31$14,218,327
Total plan assets at beginning of year2011-12-31$13,835,790
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$444,500
Other income received2011-12-31$-729,610
Net income (gross income less expenses)2011-12-31$382,537
Net plan assets at end of year (total assets less liabilities)2011-12-31$14,218,327
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$13,835,790
Assets. Value of participant loans2011-12-31$23,694
Assets. Value of assets in partnership/joint-venture interests2011-12-31$21,566
Assets. Value of real-estate (other than employer real property)2011-12-31$219,167
Total contributions received or receivable from employer(s)2011-12-31$1,033,167
2010 : ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$78,245
Total income from all sources2010-12-31$2,765,554
Total plan assets at end of year2010-12-31$13,835,790
Total plan assets at beginning of year2010-12-31$10,991,991
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$378,900
Other income received2010-12-31$1,353,362
Net income (gross income less expenses)2010-12-31$2,765,554
Net plan assets at end of year (total assets less liabilities)2010-12-31$13,835,790
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$10,991,991
Assets. Value of participant loans2010-12-31$74,167
Assets. Value of assets in partnership/joint-venture interests2010-12-31$21,668
Assets. Value of real-estate (other than employer real property)2010-12-31$220,887
Total contributions received or receivable from employer(s)2010-12-31$1,033,292

Form 5500 Responses for ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN

2018: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingYes
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. 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 – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. 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 – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. 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 – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. 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 – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. 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 – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. 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 – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: ANESTHESIA ASSOCIATES OF COLORADO SPRINGS, P.C. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract numberDA9020386
Policy instance 3
Insurance contract or identification numberDA9020386
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUNAMERICA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60941 )
Policy contract numberP61D3516792
Policy instance 2
Insurance contract or identification numberP61D3516792
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $801
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $801
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER BLAIR
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number00021A3134
Policy instance 1
Insurance contract or identification number00021A3134
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,715
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,715
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER BLAIR
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 )
Policy contract number3204793598
Policy instance 4
Insurance contract or identification number3204793598
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameGLENN GROSH
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number00021A3134
Policy instance 3
Insurance contract or identification number00021A3134
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $627
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $627
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER BLAIR
SUNAMERICA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60941 )
Policy contract numberP61D3516792
Policy instance 2
Insurance contract or identification numberP61D3516792
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,740
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,740
Insurance broker organization code?3
Insurance broker nameCHRSTOPHER BLAIR
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number009263807A
Policy instance 1
Insurance contract or identification number009263807A
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-03-06
Total amount of commissions paid to insurance brokerUSD $318
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $318
Insurance broker organization code?3
Insurance broker nameBRUCE ALLEN LARSON
ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract numberDA9020386
Policy instance 5
Insurance contract or identification numberDA9020386
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
SUNAMERICA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60941 )
Policy contract numberP61D3516792
Policy instance 5
Insurance contract or identification numberP61D3516792
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,488
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,488
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER BLAIR
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 )
Policy contract number3204793598
Policy instance 4
Insurance contract or identification number3204793598
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameGLENN GROSH
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number009263807A
Policy instance 2
Insurance contract or identification number009263807A
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,348
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,348
Insurance broker organization code?3
Insurance broker nameBRUCE ALLEN LARSON
ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract numberDA9020386
Policy instance 1
Insurance contract or identification numberDA9020386
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
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?Yes
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
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number00021A3134
Policy instance 3
Insurance contract or identification number00021A3134
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,715
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,715
Insurance broker organization code?3
Insurance broker nameCHRISTOPHER BLAIR
ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract numberDA9020386
Policy instance 1
Insurance contract or identification numberDA9020386
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
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?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker nameN/A
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 )
Policy contract number3204793598
Policy instance 4
Insurance contract or identification number3204793598
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameGLENN GROSH
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number00021A3134
Policy instance 3
Insurance contract or identification number00021A3134
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,715
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,715
Insurance broker organization code?3
Insurance broker nameTEEM D SUELTO CHFC
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number009263807A
Policy instance 2
Insurance contract or identification number009263807A
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $945
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $945
Insurance broker organization code?3
Insurance broker nameBRUCE ALLEN LARSEN
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number00021A3134
Policy instance 3
Insurance contract or identification number00021A3134
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,715
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number009263807A
Policy instance 2
Insurance contract or identification number009263807A
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,023
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract numberDA920386
Policy instance 1
Insurance contract or identification numberDA920386
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
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?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 )
Policy contract number3204793598
Policy instance 4
Insurance contract or identification number3204793598
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,599
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 )
Policy contract number3204793598
Policy instance 4
Insurance contract or identification number3204793598
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number009263807A
Policy instance 2
Insurance contract or identification number009263807A
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $938
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 )
Policy contract numberDA920386
Policy instance 1
Insurance contract or identification numberDA920386
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $475
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERITAS LIFE INSURANCE CORP. (National Association of Insurance Commissioners NAIC id number: 61301 )
Policy contract number00021A3134
Policy instance 3
Insurance contract or identification number00021A3134
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,715
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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