401k Plan data: MEDICAL ARTS CENTER RETIREMENT PLAN plan

MEDICAL ARTS CENTER RETIREMENT PLAN 401k Plan overview

Plan Name	MEDICAL ARTS CENTER RETIREMENT PLAN
Plan identification number	003

MEDICAL ARTS CENTER RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

MEDICAL ARTS CENTER CLINIC INC. has sponsored the creation of one or more 401k plans.

Company Name: MEDICAL ARTS CENTER CLINIC INC.

Employer identification number (EIN): 870282100

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL ARTS CENTER RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
003 2022-01-01 LYNN BEARD 2023-06-07
003 2021-01-01 LYNN BEARD 2022-07-06
003 2020-01-01 LYNN Q BEARD 2021-08-10 LYNN Q BEARD 2021-08-10
003 2019-01-01 LYNN BEARD 2020-07-13
003 2018-01-01 LYNN BEARD 2019-09-09
003 2017-01-01 LYNN BEARD 2018-07-09
003 2016-01-01 LYNN BEARD 2017-06-28
003 2015-01-01 LYNN BEARD 2016-06-27 LYNN BEARD 2016-06-27
003 2014-01-01 DEANNE WILLIAMS LYNN Q BEARD 2015-07-29
003 2013-01-01 LYNN BEARD
003 2012-01-01 LYNN BEARD
003 2011-01-01 LYNN BEARD
003 2009-01-01 LYNN BEARD

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
003	2022-01-01	LYNN BEARD	2023-06-07
003	2021-01-01	LYNN BEARD	2022-07-06
003	2020-01-01	LYNN Q BEARD	2021-08-10	LYNN Q BEARD	2021-08-10
003	2019-01-01	LYNN BEARD	2020-07-13
003	2018-01-01	LYNN BEARD	2019-09-09
003	2017-01-01	LYNN BEARD	2018-07-09
003	2016-01-01	LYNN BEARD	2017-06-28
003	2015-01-01	LYNN BEARD	2016-06-27	LYNN BEARD	2016-06-27
003	2014-01-01	DEANNE WILLIAMS		LYNN Q BEARD	2015-07-29
003	2013-01-01	LYNN BEARD
003	2012-01-01	LYNN BEARD
003	2011-01-01	LYNN BEARD
003	2009-01-01	LYNN BEARD

Plan Statistics for MEDICAL ARTS CENTER RETIREMENT PLAN

401k plan membership statisitcs for MEDICAL ARTS CENTER RETIREMENT PLAN

Measure Date Value
2014: MEDICAL ARTS CENTER RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 38
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 31
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 8
Total of all active and inactive participants 2014-01-01 40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 40
Number of participants with account balances 2014-01-01 37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: MEDICAL ARTS CENTER RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 34
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 9
Total of all active and inactive participants 2013-01-01 43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 43
Number of participants with account balances 2013-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 5
2012: MEDICAL ARTS CENTER RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 35
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 10
Total of all active and inactive participants 2012-01-01 45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 45
Number of participants with account balances 2012-01-01 35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 5
2011: MEDICAL ARTS CENTER RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 36
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 1
Total of all active and inactive participants 2011-01-01 37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 37
Number of participants with account balances 2011-01-01 37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: MEDICAL ARTS CENTER RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 35
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 4
Total of all active and inactive participants 2009-01-01 39
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 39
Number of participants with account balances 2009-01-01 33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2014: MEDICAL ARTS CENTER RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	38
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	31
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	8
Total of all active and inactive participants	2014-01-01	40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	40
Number of participants with account balances	2014-01-01	37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: MEDICAL ARTS CENTER RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	34
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	9
Total of all active and inactive participants	2013-01-01	43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	43
Number of participants with account balances	2013-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	5
2012: MEDICAL ARTS CENTER RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	35
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	10
Total of all active and inactive participants	2012-01-01	45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	45
Number of participants with account balances	2012-01-01	35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	5
2011: MEDICAL ARTS CENTER RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	36
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	1
Total of all active and inactive participants	2011-01-01	37
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	37
Number of participants with account balances	2011-01-01	37
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: MEDICAL ARTS CENTER RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	35
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	4
Total of all active and inactive participants	2009-01-01	39
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	39
Number of participants with account balances	2009-01-01	33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on MEDICAL ARTS CENTER RETIREMENT PLAN

Measure	Date	Value
2014 : MEDICAL ARTS CENTER RETIREMENT PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$339,746
Expenses. Total of all expenses incurred	2014-12-31	$33,454
Benefits paid (including direct rollovers)	2014-12-31	$33,383
Total plan assets at end of year	2014-12-31	$2,696,080
Total plan assets at beginning of year	2014-12-31	$2,389,788
Value of fidelity bond covering the plan	2014-12-31	$200,000
Total contributions received or receivable from participants	2014-12-31	$123,622
Expenses. Other expenses not covered elsewhere	2014-12-31	$71
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$154,668
Net income (gross income less expenses)	2014-12-31	$306,292
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$2,696,080
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$2,389,788
Assets. Value of participant loans	2014-12-31	$60,002
Total contributions received or receivable from employer(s)	2014-12-31	$61,456
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
2013 : MEDICAL ARTS CENTER RETIREMENT PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$685,931
Expenses. Total of all expenses incurred	2013-12-31	$124,962
Benefits paid (including direct rollovers)	2013-12-31	$124,752
Total plan assets at end of year	2013-12-31	$2,389,791
Total plan assets at beginning of year	2013-12-31	$1,828,822
Value of fidelity bond covering the plan	2013-12-31	$200,000
Total contributions received or receivable from participants	2013-12-31	$106,226
Expenses. Other expenses not covered elsewhere	2013-12-31	$210
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$515,981
Net income (gross income less expenses)	2013-12-31	$560,969
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,389,791
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,828,822
Assets. Value of participant loans	2013-12-31	$82,151
Total contributions received or receivable from employer(s)	2013-12-31	$63,724
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
2012 : MEDICAL ARTS CENTER RETIREMENT PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$395,558
Expenses. Total of all expenses incurred	2012-12-31	$33,312
Benefits paid (including direct rollovers)	2012-12-31	$32,822
Total plan assets at end of year	2012-12-31	$1,828,822
Total plan assets at beginning of year	2012-12-31	$1,466,576
Value of fidelity bond covering the plan	2012-12-31	$200,000
Total contributions received or receivable from participants	2012-12-31	$101,233
Expenses. Other expenses not covered elsewhere	2012-12-31	$490
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$235,310
Net income (gross income less expenses)	2012-12-31	$362,246
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,828,822
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,466,576
Assets. Value of participant loans	2012-12-31	$52,437
Total contributions received or receivable from employer(s)	2012-12-31	$59,015
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
2011 : MEDICAL ARTS CENTER RETIREMENT PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$123,337
Expenses. Total of all expenses incurred	2011-12-31	$11,554
Benefits paid (including direct rollovers)	2011-12-31	$11,414
Total plan assets at end of year	2011-12-31	$1,466,576
Total plan assets at beginning of year	2011-12-31	$1,354,793
Value of fidelity bond covering the plan	2011-12-31	$150,000
Total contributions received or receivable from participants	2011-12-31	$94,660
Expenses. Other expenses not covered elsewhere	2011-12-31	$140
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-77,988
Net income (gross income less expenses)	2011-12-31	$111,783
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,466,576
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,354,793
Assets. Value of participant loans	2011-12-31	$37,552
Total contributions received or receivable from employer(s)	2011-12-31	$106,665
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : MEDICAL ARTS CENTER RETIREMENT PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$280,770
Expenses. Total of all expenses incurred	2010-12-31	$34,654
Benefits paid (including direct rollovers)	2010-12-31	$34,584
Total plan assets at end of year	2010-12-31	$1,354,793
Total plan assets at beginning of year	2010-12-31	$1,108,677
Value of fidelity bond covering the plan	2010-12-31	$150,000
Total contributions received or receivable from participants	2010-12-31	$96,718
Expenses. Other expenses not covered elsewhere	2010-12-31	$70
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$149,556
Net income (gross income less expenses)	2010-12-31	$246,116
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,354,793
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,108,677
Assets. Value of participant loans	2010-12-31	$44,937
Total contributions received or receivable from employer(s)	2010-12-31	$34,496
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
2009 : MEDICAL ARTS CENTER RETIREMENT PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for MEDICAL ARTS CENTER RETIREMENT PLAN

2014: MEDICAL ARTS CENTER RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MEDICAL ARTS CENTER RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: MEDICAL ARTS CENTER RETIREMENT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MEDICAL ARTS CENTER RETIREMENT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2009: MEDICAL ARTS CENTER RETIREMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-027240

Policy instance

Insurance contract or identification number	GA-027240
Number of Individuals Covered	37
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $9,514
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,514
Insurance broker organization code?	3
Insurance broker name	EDWARD D JONES & CO L P.

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

Policy contract number

GA-027240

Policy instance

Insurance contract or identification number	GA-027240
Number of Individuals Covered	37
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,351
Total amount of fees paid to insurance company	USD $1,114
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

GA-027240

Policy instance

Insurance contract or identification number	GA-027240
Number of Individuals Covered	34
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,315
Total amount of fees paid to insurance company	USD $900
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,315
Insurance broker organization code?	3
Amount paid for insurance broker fees	900
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker name	EDWARD D JONES & CO

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Company Name:	MEDICAL ARTS CENTER CLINIC INC.
Employer identification number (EIN):	870282100
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)