401k Plan data: JOHN ILIESCU PROFIT SHARING PLAN plan

JOHN ILIESCU PROFIT SHARING PLAN 401k Plan overview

Plan Name	JOHN ILIESCU PROFIT SHARING PLAN
Plan identification number	001

JOHN ILIESCU PROFIT SHARING PLAN Benefits

401k Plan Type	Defined Contribution Pension
Plan Features/Benefits	Profit-sharing 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

JOHN ILIESCU PROFIT SHARING PLAN has sponsored the creation of one or more 401k plans.

Company Name: JOHN ILIESCU PROFIT SHARING PLAN

Employer identification number (EIN): 880321942

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOHN ILIESCU PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 JOHN ILIESCU JOHN ILIESCU 2018-10-13
001 2016-01-01 JOHN ILIESCU JOHN ILIESCU 2017-07-26
001 2015-01-01 JOHN ILIESCU JOHN ILIESCU 2016-07-28
001 2014-01-01 JOHN ILIESCU JOHN ILIESCU 2015-07-24
001 2013-01-01 JOHN ILIESCU JOHN ILIESCU 2014-07-15
001 2012-01-01 JOHN ILIESCU JOHN ILIESCU 2013-07-24
001 2011-01-01 JOHN ILIESCU JOHN ILIESCU 2012-07-31
001 2010-01-01 JOHN ILIESCU JOHN ILIESCU 2011-07-26
001 2009-01-01 JOHN ILIESCU JOHN ILIESCU 2010-07-08
001 2009-01-01 JOHN ILIESCU JOHN ILIESCU 2010-07-15
001 2009-01-01 JOHN ILIESCU
001 2009-01-01 JOHN ILIESCU

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01	JOHN ILIESCU	JOHN ILIESCU	2018-10-13
001	2016-01-01	JOHN ILIESCU	JOHN ILIESCU	2017-07-26
001	2015-01-01	JOHN ILIESCU	JOHN ILIESCU	2016-07-28
001	2014-01-01	JOHN ILIESCU	JOHN ILIESCU	2015-07-24
001	2013-01-01	JOHN ILIESCU	JOHN ILIESCU	2014-07-15
001	2012-01-01	JOHN ILIESCU	JOHN ILIESCU	2013-07-24
001	2011-01-01	JOHN ILIESCU	JOHN ILIESCU	2012-07-31
001	2010-01-01	JOHN ILIESCU	JOHN ILIESCU	2011-07-26
001	2009-01-01	JOHN ILIESCU	JOHN ILIESCU	2010-07-08
001	2009-01-01	JOHN ILIESCU	JOHN ILIESCU	2010-07-15
001	2009-01-01	JOHN ILIESCU
001	2009-01-01	JOHN ILIESCU

Financial Data on JOHN ILIESCU PROFIT SHARING PLAN

Measure	Date	Value
2020 : JOHN ILIESCU PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources	2020-12-31	$0
Expenses. Total of all expenses incurred	2020-12-31	$268,844
Benefits paid (including direct rollovers)	2020-12-31	$268,844
Total plan assets at end of year	2020-12-31	$0
Total plan assets at beginning of year	2020-12-31	$268,844
Net income (gross income less expenses)	2020-12-31	$-268,844
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$268,844
Assets. Value of real-estate (other than employer real property)	2020-12-31	$0
2019 : JOHN ILIESCU PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$3,154
Total plan assets at end of year	2019-12-31	$268,844
Total plan assets at beginning of year	2019-12-31	$265,690
Other income received	2019-12-31	$3,154
Net income (gross income less expenses)	2019-12-31	$3,154
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$268,844
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$265,690
2018 : JOHN ILIESCU PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$555,010
Expenses. Total of all expenses incurred	2018-12-31	$3,495,105
Benefits paid (including direct rollovers)	2018-12-31	$3,481,682
Total plan assets at end of year	2018-12-31	$265,690
Total plan assets at beginning of year	2018-12-31	$3,205,785
Expenses. Other expenses not covered elsewhere	2018-12-31	$8,173
Other income received	2018-12-31	$555,010
Net income (gross income less expenses)	2018-12-31	$-2,940,095
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$265,690
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$3,205,785
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$5,250
2017 : JOHN ILIESCU PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$234,907
Expenses. Total of all expenses incurred	2017-12-31	$227,315
Benefits paid (including direct rollovers)	2017-12-31	$207,687
Total plan assets at end of year	2017-12-31	$3,205,785
Total plan assets at beginning of year	2017-12-31	$3,198,193
Assets. Value of tangible personal property	2017-12-31	$5,831
Assets. Value of loans (other than to participants)	2017-12-31	$25,000
Expenses. Other expenses not covered elsewhere	2017-12-31	$19,628
Other income received	2017-12-31	$234,907
Net income (gross income less expenses)	2017-12-31	$7,592
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$3,205,785
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$3,198,193
Assets. Value of real-estate (other than employer real property)	2017-12-31	$2,307,881
2016 : JOHN ILIESCU PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$228,574
Expenses. Total of all expenses incurred	2016-12-31	$221,272
Benefits paid (including direct rollovers)	2016-12-31	$197,624
Total plan assets at end of year	2016-12-31	$3,198,193
Total plan assets at beginning of year	2016-12-31	$3,190,891
Assets. Value of tangible personal property	2016-12-31	$5,831
Assets. Value of loans (other than to participants)	2016-12-31	$25,000
Expenses. Other expenses not covered elsewhere	2016-12-31	$21,773
Other income received	2016-12-31	$228,574
Net income (gross income less expenses)	2016-12-31	$7,302
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$3,198,193
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$3,190,891
Assets. Value of real-estate (other than employer real property)	2016-12-31	$2,307,881
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$1,875
2015 : JOHN ILIESCU PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$247,428
Expenses. Total of all expenses incurred	2015-12-31	$211,752
Benefits paid (including direct rollovers)	2015-12-31	$186,287
Total plan assets at end of year	2015-12-31	$3,190,891
Total plan assets at beginning of year	2015-12-31	$3,155,215
Assets. Value of tangible personal property	2015-12-31	$5,831
Assets. Value of loans (other than to participants)	2015-12-31	$25,000
Expenses. Other expenses not covered elsewhere	2015-12-31	$24,556
Other income received	2015-12-31	$247,428
Net income (gross income less expenses)	2015-12-31	$35,676
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$3,190,891
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$3,155,215
Assets. Value of real-estate (other than employer real property)	2015-12-31	$2,307,881
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$909
2014 : JOHN ILIESCU PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$241,589
Expenses. Total of all expenses incurred	2014-12-31	$203,556
Benefits paid (including direct rollovers)	2014-12-31	$176,768
Total plan assets at end of year	2014-12-31	$3,155,215
Total plan assets at beginning of year	2014-12-31	$3,117,182
Assets. Value of tangible personal property	2014-12-31	$5,831
Assets. Value of loans (other than to participants)	2014-12-31	$25,000
Expenses. Other expenses not covered elsewhere	2014-12-31	$25,661
Other income received	2014-12-31	$241,589
Net income (gross income less expenses)	2014-12-31	$38,033
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$3,155,215
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$3,117,182
Assets. Value of real-estate (other than employer real property)	2014-12-31	$2,307,881
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$1,127
2013 : JOHN ILIESCU PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$199,822
Expenses. Total of all expenses incurred	2013-12-31	$196,237
Benefits paid (including direct rollovers)	2013-12-31	$174,834
Total plan assets at end of year	2013-12-31	$3,117,182
Total plan assets at beginning of year	2013-12-31	$3,113,597
Assets. Value of tangible personal property	2013-12-31	$5,831
Assets. Value of loans (other than to participants)	2013-12-31	$25,000
Expenses. Other expenses not covered elsewhere	2013-12-31	$20,508
Other income received	2013-12-31	$199,822
Net income (gross income less expenses)	2013-12-31	$3,585
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$3,117,182
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$3,113,597
Assets. Value of real-estate (other than employer real property)	2013-12-31	$2,307,881
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$895
2012 : JOHN ILIESCU PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$248,057
Expenses. Total of all expenses incurred	2012-12-31	$197,951
Benefits paid (including direct rollovers)	2012-12-31	$167,831
Total plan assets at end of year	2012-12-31	$3,113,597
Total plan assets at beginning of year	2012-12-31	$3,063,491
Assets. Value of tangible personal property	2012-12-31	$5,831
Assets. Value of loans (other than to participants)	2012-12-31	$25,000
Expenses. Other expenses not covered elsewhere	2012-12-31	$28,995
Other income received	2012-12-31	$248,057
Net income (gross income less expenses)	2012-12-31	$50,106
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$3,113,597
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$3,063,491
Assets. Value of real-estate (other than employer real property)	2012-12-31	$2,307,881
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$1,125
2011 : JOHN ILIESCU PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$223,226
Expenses. Total of all expenses incurred	2011-12-31	$148,606
Benefits paid (including direct rollovers)	2011-12-31	$138,781
Total plan assets at end of year	2011-12-31	$3,063,491
Total plan assets at beginning of year	2011-12-31	$2,988,871
Assets. Value of tangible personal property	2011-12-31	$5,831
Assets. Value of loans (other than to participants)	2011-12-31	$25,000
Expenses. Other expenses not covered elsewhere	2011-12-31	$6,126
Other income received	2011-12-31	$223,226
Net income (gross income less expenses)	2011-12-31	$74,620
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$3,063,491
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,988,871
Assets. Value of real-estate (other than employer real property)	2011-12-31	$2,307,881
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$3,699
2010 : JOHN ILIESCU PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$211,034
Expenses. Total of all expenses incurred	2010-12-31	$162,930
Benefits paid (including direct rollovers)	2010-12-31	$133,825
Total plan assets at end of year	2010-12-31	$2,989,507
Total plan assets at beginning of year	2010-12-31	$2,941,403
Assets. Value of tangible personal property	2010-12-31	$5,831
Assets. Value of loans (other than to participants)	2010-12-31	$25,000
Other income received	2010-12-31	$211,034
Net income (gross income less expenses)	2010-12-31	$48,104
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,989,507
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,941,403
Assets. Value of real-estate (other than employer real property)	2010-12-31	$2,307,881
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$29,105

Form 5500 Responses for JOHN ILIESCU PROFIT SHARING PLAN

2020: JOHN ILIESCU PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	This submission is the final filing	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: JOHN ILIESCU PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: JOHN ILIESCU PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: JOHN ILIESCU PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: JOHN ILIESCU PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: JOHN ILIESCU PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: JOHN ILIESCU PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: JOHN ILIESCU PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: JOHN ILIESCU PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: JOHN ILIESCU PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: JOHN ILIESCU PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: JOHN ILIESCU PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70161038
Policy instance	2
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	P1088124
Policy instance	5
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	P1105454
Policy instance	4
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	P1037083
Policy instance	3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70006947
Policy instance	1
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	P1040268
Policy instance	6
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	P1088124
Policy instance	5
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70006947
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	P1105454
Policy instance	4
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	P1040268
Policy instance	6
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70161038
Policy instance	2
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	P1037083
Policy instance	3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70006947
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70161038
Policy instance	2
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	P1088124
Policy instance	5
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	P1105454
Policy instance	4
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	P1040268
Policy instance	6
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number	P1037083
Policy instance	3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70006947
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70161038
Policy instance	2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q02
Policy instance	4
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q01
Policy instance	3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q02
Policy instance	4
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q01
Policy instance	3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70161038
Policy instance	2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70006947
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q01
Policy instance	3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70161038
Policy instance	2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70006947
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q02
Policy instance	4
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70161038
Policy instance	2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70006947
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q01
Policy instance	3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q02
Policy instance	4
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70006947
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q01
Policy instance	3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q02
Policy instance	4
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70161038
Policy instance	2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q02
Policy instance	4
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70006947
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70161038
Policy instance	2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q01
Policy instance	3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70006947
Policy instance	1
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	70161038
Policy instance	2
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q02
Policy instance	4
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number	901967Q01
Policy instance	3

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Company Name:	JOHN ILIESCU PROFIT SHARING PLAN
Employer identification number (EIN):	880321942
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)