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ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 401k Plan overview

Plan NameALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN
Plan identification number 003

ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • 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

SUTTER EAST BAY HOSPITALS has sponsored the creation of one or more 401k plans.

Company Name:SUTTER EAST BAY HOSPITALS
Employer identification number (EIN):941196176
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about SUTTER EAST BAY HOSPITALS

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C0169633

More information about SUTTER EAST BAY HOSPITALS

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032017-01-01VICTORIA FLEMMING
0032016-01-01VICTORIA FLEMMING
0032015-01-01VICTORIA FLEMMING
0032014-01-01VICTORIA FLEMMING
0032013-01-01VICTORIA FLEMMING
0032012-01-01VICTORIA FLEMMING
0032011-01-01MARK BEITING
0032010-01-01MARK BEITING
0032009-01-01MARK BEITING

Plan Statistics for ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN

401k plan membership statisitcs for ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN

Measure Date Value
2017: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01655
Total number of active participants reported on line 7a of the Form 55002017-01-01275
Number of retired or separated participants receiving benefits2017-01-0140
Number of other retired or separated participants entitled to future benefits2017-01-01283
Total of all active and inactive participants2017-01-01598
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-017
Total participants2017-01-01605
Number of participants with account balances2017-01-01605
2016: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,569
Total number of active participants reported on line 7a of the Form 55002016-01-01296
Number of retired or separated participants receiving benefits2016-01-0132
Number of other retired or separated participants entitled to future benefits2016-01-01319
Total of all active and inactive participants2016-01-01647
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-018
Total participants2016-01-01655
Number of participants with account balances2016-01-01655
2015: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,678
Total number of active participants reported on line 7a of the Form 55002015-01-01846
Number of retired or separated participants receiving benefits2015-01-0138
Number of other retired or separated participants entitled to future benefits2015-01-01675
Total of all active and inactive participants2015-01-011,559
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-0110
Total participants2015-01-011,569
Number of participants with account balances2015-01-011,569
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,798
Total number of active participants reported on line 7a of the Form 55002014-01-01924
Number of retired or separated participants receiving benefits2014-01-0112
Number of other retired or separated participants entitled to future benefits2014-01-01736
Total of all active and inactive participants2014-01-011,672
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-016
Total participants2014-01-011,678
Number of participants with account balances2014-01-011,678
2013: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,896
Total number of active participants reported on line 7a of the Form 55002013-01-01989
Number of retired or separated participants receiving benefits2013-01-0112
Number of other retired or separated participants entitled to future benefits2013-01-01791
Total of all active and inactive participants2013-01-011,792
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-016
Total participants2013-01-011,798
Number of participants with account balances2013-01-011,798
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-012,002
Total number of active participants reported on line 7a of the Form 55002012-01-011,128
Number of retired or separated participants receiving benefits2012-01-0127
Number of other retired or separated participants entitled to future benefits2012-01-01734
Total of all active and inactive participants2012-01-011,889
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-017
Total participants2012-01-011,896
Number of participants with account balances2012-01-011,896
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-012,065
Total number of active participants reported on line 7a of the Form 55002011-01-011,173
Number of retired or separated participants receiving benefits2011-01-0121
Number of other retired or separated participants entitled to future benefits2011-01-01807
Total of all active and inactive participants2011-01-012,001
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-011
Total participants2011-01-012,002
Number of participants with account balances2011-01-012,002
2010: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-012,142
Total number of active participants reported on line 7a of the Form 55002010-01-011,264
Number of retired or separated participants receiving benefits2010-01-0114
Number of other retired or separated participants entitled to future benefits2010-01-01786
Total of all active and inactive participants2010-01-012,064
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-011
Total participants2010-01-012,065
Number of participants with account balances2010-01-012,065
2009: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-012,237
Total number of active participants reported on line 7a of the Form 55002009-01-011,342
Number of retired or separated participants receiving benefits2009-01-0114
Number of other retired or separated participants entitled to future benefits2009-01-01785
Total of all active and inactive participants2009-01-012,141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-011
Total participants2009-01-012,142
Number of participants with account balances2009-01-012,142

Financial Data on ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN

Measure Date Value
2017 : ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$651
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$20,345
Total income from all sources (including contributions)2017-12-31$2,128,675
Total of all expenses incurred2017-12-31$1,716,695
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$1,700,579
Expenses. Certain deemed distributions of participant loans2017-12-31$14,176
Value of total assets at end of year2017-12-31$21,475,294
Value of total assets at beginning of year2017-12-31$21,083,008
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$1,940
Total interest from all sources2017-12-31$358,879
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$294,510
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$294,510
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$10,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Participant contributions at end of year2017-12-31$85,510
Participant contributions at beginning of year2017-12-31$148,687
Administrative expenses (other) incurred2017-12-31$1,940
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$411,980
Value of net assets at end of year (total assets less liabilities)2017-12-31$21,474,643
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$21,062,663
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$4,921,790
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$4,390,812
Value of interest in pooled separate accounts at end of year2017-12-31$5,829,786
Value of interest in pooled separate accounts at beginning of year2017-12-31$5,469,013
Interest on participant loans2017-12-31$5,540
Interest earned on other investments2017-12-31$353,339
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$10,638,208
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$11,074,496
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$1,475,286
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$1,700,579
Liabilities. Value of benefit claims payable at end of year2017-12-31$651
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$20,345
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31MOSS ADAMS LLP
Accountancy firm EIN2017-12-31910189318
2016 : ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2016 401k financial data
Total transfer of assets from this plan2016-12-31$26,737,889
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$20,345
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$1,919,085
Total of all expenses incurred2016-12-31$4,309,806
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$4,286,609
Expenses. Certain deemed distributions of participant loans2016-12-31$1,847
Value of total assets at end of year2016-12-31$21,083,008
Value of total assets at beginning of year2016-12-31$50,191,273
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$21,350
Total interest from all sources2016-12-31$525,545
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$364,844
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$364,844
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$10,000,000
If this is an individual account plan, was there a blackout period2016-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Participant contributions at end of year2016-12-31$148,687
Participant contributions at beginning of year2016-12-31$381,633
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$14,419
Other income not declared elsewhere2016-12-31$13,302
Administrative expenses (other) incurred2016-12-31$21,350
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-2,390,721
Value of net assets at end of year (total assets less liabilities)2016-12-31$21,062,663
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$50,191,273
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$4,390,812
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$26,223,245
Value of interest in pooled separate accounts at end of year2016-12-31$5,469,013
Value of interest in pooled separate accounts at beginning of year2016-12-31$6,165,827
Interest on participant loans2016-12-31$10,891
Interest earned on other investments2016-12-31$514,654
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$11,074,496
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$17,406,149
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$1,015,394
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$4,286,609
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31Yes
Liabilities. Value of benefit claims payable at end of year2016-12-31$20,345
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$0
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31MOSS ADAMS LLP
Accountancy firm EIN2016-12-31910189318
2015 : ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2015 401k financial data
Total transfer of assets from this plan2015-12-31$259,269
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$252,209
Total income from all sources (including contributions)2015-12-31$917,953
Total of all expenses incurred2015-12-31$4,472,560
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$4,330,492
Expenses. Certain deemed distributions of participant loans2015-12-31$137,496
Value of total assets at end of year2015-12-31$50,191,273
Value of total assets at beginning of year2015-12-31$54,257,358
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$4,572
Total interest from all sources2015-12-31$639,199
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$1,281,762
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$1,281,762
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$10,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Participant contributions at end of year2015-12-31$381,633
Participant contributions at beginning of year2015-12-31$595,550
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$14,419
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$3,892
Other income not declared elsewhere2015-12-31$24,801
Administrative expenses (other) incurred2015-12-31$4,572
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-3,554,607
Value of net assets at end of year (total assets less liabilities)2015-12-31$50,191,273
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$54,005,149
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$26,223,245
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$34,381,333
Value of interest in pooled separate accounts at end of year2015-12-31$6,165,827
Value of interest in pooled separate accounts at beginning of year2015-12-31$624,381
Interest on participant loans2015-12-31$25,286
Interest earned on other investments2015-12-31$613,913
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$17,406,149
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$18,652,202
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-1,027,809
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$4,330,492
Liabilities. Value of benefit claims payable at end of year2015-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$252,209
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31MOSS ADAMS LLP
Accountancy firm EIN2015-12-31910189318
2014 : ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2014 401k financial data
Total transfer of assets from this plan2014-12-31$339,928
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$252,209
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$157,509
Total income from all sources (including contributions)2014-12-31$3,236,147
Total of all expenses incurred2014-12-31$5,769,142
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$5,724,327
Expenses. Certain deemed distributions of participant loans2014-12-31$38,711
Value of total assets at end of year2014-12-31$54,257,358
Value of total assets at beginning of year2014-12-31$57,035,581
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$6,104
Total interest from all sources2014-12-31$680,581
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$1,534,034
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$1,534,034
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$10,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Participant contributions at end of year2014-12-31$595,550
Participant contributions at beginning of year2014-12-31$719,091
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$3,892
Other income not declared elsewhere2014-12-31$20,101
Administrative expenses (other) incurred2014-12-31$6,104
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-2,532,995
Value of net assets at end of year (total assets less liabilities)2014-12-31$54,005,149
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$56,878,072
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$34,381,333
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$35,201,948
Value of interest in pooled separate accounts at end of year2014-12-31$624,381
Value of interest in pooled separate accounts at beginning of year2014-12-31$649,650
Interest on participant loans2014-12-31$28,072
Interest earned on other investments2014-12-31$652,509
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$18,652,202
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$20,464,892
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$1,001,431
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$5,724,327
Liabilities. Value of benefit claims payable at end of year2014-12-31$252,209
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$157,509
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31MOSS ADAMS LLP
Accountancy firm EIN2014-12-31910189318
2013 : ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total transfer of assets to this plan2013-12-31$-553,196
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$157,509
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$32,648
Total income from all sources (including contributions)2013-12-31$7,260,972
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$4,721,967
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$4,737,437
Expenses. Certain deemed distributions of participant loans2013-12-31$-21,907
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$0
Value of total assets at end of year2013-12-31$57,035,581
Value of total assets at beginning of year2013-12-31$54,924,911
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$6,437
Total interest from all sources2013-12-31$739,544
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$1,101,964
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$1,101,964
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$10,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Participant contributions at end of year2013-12-31$719,091
Participant contributions at beginning of year2013-12-31$794,896
Administrative expenses (other) incurred2013-12-31$2,989
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$2,539,005
Value of net assets at end of year (total assets less liabilities)2013-12-31$56,878,072
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$54,892,263
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$35,201,948
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$32,076,553
Value of interest in pooled separate accounts at end of year2013-12-31$649,650
Value of interest in pooled separate accounts at beginning of year2013-12-31$711,262
Interest on participant loans2013-12-31$38,525
Interest earned on other investments2013-12-31$701,019
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$20,464,892
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$21,342,200
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$5,419,464
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$4,737,437
Contract administrator fees2013-12-31$3,448
Liabilities. Value of benefit claims payable at end of year2013-12-31$157,509
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$32,648
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31ERNST & YOUNG LLP
Accountancy firm EIN2013-12-31346565596
2012 : ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total transfer of assets from this plan2012-12-31$235,649
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$32,648
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$56,085
Total income from all sources (including contributions)2012-12-31$4,353,108
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$4,070,436
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$4,054,464
Expenses. Certain deemed distributions of participant loans2012-12-31$9,270
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$0
Value of total assets at end of year2012-12-31$54,924,911
Value of total assets at beginning of year2012-12-31$54,901,325
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$6,702
Total interest from all sources2012-12-31$793,752
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$516,673
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$516,673
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$10,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Participant contributions at end of year2012-12-31$794,896
Participant contributions at beginning of year2012-12-31$965,153
Administrative expenses (other) incurred2012-12-31$3,168
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$282,672
Value of net assets at end of year (total assets less liabilities)2012-12-31$54,892,263
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$54,845,240
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$32,076,553
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$31,148,846
Value of interest in pooled separate accounts at end of year2012-12-31$711,262
Value of interest in pooled separate accounts at beginning of year2012-12-31$763,461
Interest on participant loans2012-12-31$42,092
Interest earned on other investments2012-12-31$751,660
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$21,342,200
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$22,023,865
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$3,042,683
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$4,054,464
Contract administrator fees2012-12-31$3,534
Liabilities. Value of benefit claims payable at end of year2012-12-31$32,648
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$56,085
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31ERNST & YOUNG LLP
Accountancy firm EIN2012-12-31346565596
2011 : ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2011 401k financial data
Total transfer of assets from this plan2011-12-31$5,262
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$56,085
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$27,000
Total income from all sources (including contributions)2011-12-31$435,127
Total of all expenses incurred2011-12-31$3,799,766
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$3,779,541
Expenses. Certain deemed distributions of participant loans2011-12-31$13,004
Value of total assets at end of year2011-12-31$54,901,325
Value of total assets at beginning of year2011-12-31$58,242,141
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$7,221
Total interest from all sources2011-12-31$822,549
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$448,430
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$448,430
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$10,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Participant contributions at end of year2011-12-31$965,153
Participant contributions at beginning of year2011-12-31$879,869
Administrative expenses (other) incurred2011-12-31$7,221
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-3,364,639
Value of net assets at end of year (total assets less liabilities)2011-12-31$54,845,240
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$58,215,141
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$31,148,846
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$30,392,309
Value of interest in pooled separate accounts at end of year2011-12-31$763,461
Interest on participant loans2011-12-31$52,106
Interest earned on other investments2011-12-31$770,443
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$3,369,722
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$3,369,722
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$22,023,865
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$23,600,241
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-835,852
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$3,779,541
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Liabilities. Value of benefit claims payable at end of year2011-12-31$56,085
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$27,000
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31CROWE HORWATH LLP
Accountancy firm EIN2011-12-31350921680
2010 : ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2010 401k financial data
Total transfer of assets from this plan2010-12-31$258,804
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$27,000
Total income from all sources (including contributions)2010-12-31$4,491,424
Total of all expenses incurred2010-12-31$2,929,051
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$2,871,100
Expenses. Certain deemed distributions of participant loans2010-12-31$50,626
Value of total assets at end of year2010-12-31$58,242,141
Value of total assets at beginning of year2010-12-31$56,911,572
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$7,325
Total interest from all sources2010-12-31$836,208
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$353,056
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$353,056
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$10,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Participant contributions at end of year2010-12-31$879,869
Participant contributions at beginning of year2010-12-31$811,200
Administrative expenses (other) incurred2010-12-31$7,325
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$1,562,373
Value of net assets at end of year (total assets less liabilities)2010-12-31$58,215,141
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$56,911,572
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$30,392,309
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$28,922,200
Interest on participant loans2010-12-31$47,984
Interest earned on other investments2010-12-31$787,229
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$3,369,722
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$3,702,676
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$3,702,676
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$995
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$23,600,241
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$23,475,496
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$3,302,160
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$2,871,100
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Liabilities. Value of benefit claims payable at end of year2010-12-31$27,000
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31PERRY-SMITH, LLP
Accountancy firm EIN2010-12-31680041802

Form 5500 Responses for ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN

2017: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: ALTA BATES SUMMIT 403(B) TDA RETIREMENT 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 planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedYes
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: ALTA BATES SUMMIT 403(B) TDA RETIREMENT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE0771
Policy instance 2
Insurance contract or identification numberVE0771
Number of Individuals Covered113
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,885
Total amount of fees paid to insurance companyUSD $761
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,429
Amount paid for insurance broker fees761
Additional information about fees paid to insurance brokerSUPPLEMENTAL CASH PAID
Insurance broker organization code?3
Insurance broker nameLINDA MACIOCI
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number004633
Policy instance 1
Insurance contract or identification number004633
Number of Individuals Covered528
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,146
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1146
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker organization code?3
Insurance broker namePRUCO SECURITIES CORPORATION
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number004633
Policy instance 1
Insurance contract or identification number004633
Number of Individuals Covered317
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,208
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1208
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker organization code?3
Insurance broker namePRUCO SECURITIES CORPORATION
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberFA068883
Policy instance 2
Insurance contract or identification numberFA068883
Number of Individuals Covered321
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $15,245
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,245
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SERVICES
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE0771
Policy instance 3
Insurance contract or identification numberVE0771
Number of Individuals Covered142
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,618
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,618
Insurance broker organization code?3
Insurance broker nameLINDA MACIOCI
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number26001-071,072
Policy instance 4
Insurance contract or identification number26001-071,072
Number of Individuals Covered62
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,220
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1220
Additional information about fees paid to insurance brokerOTHER FEES FOR SERVICE
Insurance broker organization code?3
Insurance broker nameFIDELITY INSURANCE AGENCY
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number26001-071,072
Policy instance 4
Insurance contract or identification number26001-071,072
Number of Individuals Covered83
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,336
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1336
Insurance broker organization code?3
Insurance broker nameFIDELITY INSURANCE AGENCY
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE0771
Policy instance 3
Insurance contract or identification numberVE0771
Number of Individuals Covered154
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $6,535
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
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,535
Insurance broker organization code?3
Insurance broker nameLINDA MACIOCI
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberFA068883
Policy instance 2
Insurance contract or identification numberFA068883
Number of Individuals Covered195
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $16,275
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
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,275
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SERVICES
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number004633
Policy instance 1
Insurance contract or identification number004633
Number of Individuals Covered611
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
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 Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE0771
Policy instance 4
Insurance contract or identification numberVE0771
Number of Individuals Covered166
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $7,368
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
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 $7,368
Insurance broker organization code?3
Insurance broker nameLINDA MACIOCI
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number26001-071,072
Policy instance 3
Insurance contract or identification number26001-071,072
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 $1,371
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?Yes
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
Amount paid for insurance broker fees1371
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameFIDELITY INSURANCE AGENCY
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberFA068883
Policy instance 1
Insurance contract or identification numberFA068883
Number of Individuals Covered379
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $10,916
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,916
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SERVICES
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number004633
Policy instance 2
Insurance contract or identification number004633
Number of Individuals Covered658
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?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 Administration1
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
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE0771
Policy instance 2
Insurance contract or identification numberVE0771
Number of Individuals Covered179
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,506
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
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
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberFA068883
Policy instance 1
Insurance contract or identification numberFA068883
Number of Individuals Covered407
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11,736
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number26001-071,072
Policy instance 3
Insurance contract or identification number26001-071,072
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 $1,495
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?Yes
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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number004481
Policy instance 4
Insurance contract or identification number004481
Number of Individuals Covered678
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 $1,275
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 Administration1
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
Amount paid for insurance broker fees1275
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PROVIDER
Insurance broker organization code?3
Insurance broker namePRUCO SECURITIES CORPORATION
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number26001-071,072
Policy instance 1
Insurance contract or identification number26001-071,072
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 $1,495
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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1495
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameFIDELITY INSURANCE AGENCY
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberFA068883
Policy instance 2
Insurance contract or identification numberFA068883
Number of Individuals Covered407
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11,736
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
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 $11,736
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SERVICES
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE0771
Policy instance 3
Insurance contract or identification numberVE0771
Number of Individuals Covered179
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,506
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $7,506
Insurance broker organization code?3
Insurance broker nameLINDA MACIOCI
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number26001-071/072
Policy instance 4
Insurance contract or identification number26001-071/072
Number of Individuals Covered894
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 $1,697
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE0771
Policy instance 3
Insurance contract or identification numberVE0771
Number of Individuals Covered188
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $7,730
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 Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberFA068883
Policy instance 2
Insurance contract or identification numberFA068883
Number of Individuals Covered438
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $12,401
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 Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number4481
Policy instance 1
Insurance contract or identification number4481
Number of Individuals Covered706
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 $1,282
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number26001-071/072
Policy instance 4
Insurance contract or identification number26001-071/072
Number of Individuals Covered929
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 $1,758
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1758
Insurance broker organization code?3
Insurance broker nameFIDELITY INSURANCE AGENCY
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract numberVE0771
Policy instance 3
Insurance contract or identification numberVE0771
Number of Individuals Covered187
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $7,628
Total amount of fees paid to insurance companyUSD $86
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,628
Amount paid for insurance broker fees86
Additional information about fees paid to insurance brokerSUPPLEMENTAL CASH PAID
Insurance broker organization code?3
Insurance broker nameLINDA MACIOCI
TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract numberFA068883
Policy instance 2
Insurance contract or identification numberFA068883
Number of Individuals Covered471
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $12,600
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 Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,600
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SERVICES, INC.
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number004633
Policy instance 1
Insurance contract or identification number004633
Number of Individuals Covered717
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 $1,309
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration1
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1309
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker organization code?3
Insurance broker namePRUCO SECURITIES CORPORATION

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