401k Plan data: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN plan

JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 401k Plan overview

Plan Name	JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN
Plan identification number	001

JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
Plan covering Self-Employed individuals.
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.
Life insurance
Long-term disability cover

401k Sponsoring company profile

JIM BLECHMAN SOLE PROPRIETOR has sponsored the creation of one or more 401k plans.

Company Name: JIM BLECHMAN SOLE PROPRIETOR

Employer identification number (EIN): 953384525

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 JIM BLECHMAN 2023-10-12
001 2021-01-01 JIM BLECHMAN 2022-10-11
001 2020-01-01 JIM BLECHMAN 2021-08-31
001 2019-01-01 JIM BLECHMAN 2020-10-09
001 2018-01-01 JIM BLECHMAN 2019-10-08
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01 JIM BLECHMAN
001 2013-01-01 JIM BLECHMAN
001 2012-01-01 JIM BLECHMAN
001 2011-01-01 JIM BLECHMAN
001 2009-01-01 JIM BLECHMAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	JIM BLECHMAN	2023-10-12
001	2021-01-01	JIM BLECHMAN	2022-10-11
001	2020-01-01	JIM BLECHMAN	2021-08-31
001	2019-01-01	JIM BLECHMAN	2020-10-09
001	2018-01-01	JIM BLECHMAN	2019-10-08
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01	JIM BLECHMAN
001	2013-01-01	JIM BLECHMAN
001	2012-01-01	JIM BLECHMAN
001	2011-01-01	JIM BLECHMAN
001	2009-01-01	JIM BLECHMAN

Plan Statistics for JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN

401k plan membership statisitcs for JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN

Measure Date Value
2022: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 3
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 1
Total of all active and inactive participants 2022-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 4
Number of participants with account balances 2022-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 1
2021: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 4
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 3
Total of all active and inactive participants 2021-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 7
Number of participants with account balances 2021-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 7
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 7
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 7
Number of participants with account balances 2020-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 7
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 7
Total participants 2019-01-01 7
Number of participants with account balances 2019-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 8
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 8
Number of participants with account balances 2018-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 7
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 3
Total of all active and inactive participants 2017-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 10
Number of participants with account balances 2017-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 2
2016: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 9
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 9
Number of participants with account balances 2016-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 9
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 9
Number of participants with account balances 2015-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 9
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 9
Number of participants with account balances 2014-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 9
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 9
Number of participants with account balances 2013-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 9
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 9
Number of participants with account balances 2012-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 9
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 9
Number of participants with account balances 2011-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 1
2009: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 9
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 9
Number of participants with account balances 2009-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2022: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	3
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	1
Total of all active and inactive participants	2022-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	4
Number of participants with account balances	2022-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	1
2021: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	4
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	3
Total of all active and inactive participants	2021-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	7
Number of participants with account balances	2021-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	7
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	7
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	7
Number of participants with account balances	2020-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	7
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	7
Total participants	2019-01-01	7
Number of participants with account balances	2019-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	8
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	8
Number of participants with account balances	2018-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	7
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	3
Total of all active and inactive participants	2017-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	10
Number of participants with account balances	2017-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	2
2016: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	9
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	9
Number of participants with account balances	2016-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	9
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	9
Number of participants with account balances	2015-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	9
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	9
Number of participants with account balances	2014-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	9
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	9
Number of participants with account balances	2013-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	9
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	9
Number of participants with account balances	2012-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	9
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	9
Number of participants with account balances	2011-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	1
2009: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	9
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	9
Number of participants with account balances	2009-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN

Measure	Date	Value
2022 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2022 401k financial data
Transfers to/from the plan	2022-12-31	$0
Total plan liabilities at end of year	2022-12-31	$0
Total plan liabilities at beginning of year	2022-12-31	$0
Total income from all sources	2022-12-31	$-253,118
Expenses. Total of all expenses incurred	2022-12-31	$112,541
Benefits paid (including direct rollovers)	2022-12-31	$97,914
Total plan assets at end of year	2022-12-31	$1,220,147
Total plan assets at beginning of year	2022-12-31	$1,585,806
Value of fidelity bond covering the plan	2022-12-31	$200,000
Total contributions received or receivable from participants	2022-12-31	$0
Expenses. Other expenses not covered elsewhere	2022-12-31	$0
Contributions received from other sources (not participants or employers)	2022-12-31	$0
Other income received	2022-12-31	$-270,818
Noncash contributions received	2022-12-31	$0
Net income (gross income less expenses)	2022-12-31	$-365,659
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$1,220,147
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$1,585,806
Total contributions received or receivable from employer(s)	2022-12-31	$17,700
Value of certain deemed distributions of participant loans	2022-12-31	$0
Value of corrective distributions	2022-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$14,627
2021 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2021 401k financial data
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$190,585
Expenses. Total of all expenses incurred	2021-12-31	$216,844
Benefits paid (including direct rollovers)	2021-12-31	$203,516
Total plan assets at end of year	2021-12-31	$1,585,806
Total plan assets at beginning of year	2021-12-31	$1,612,065
Value of fidelity bond covering the plan	2021-12-31	$200,000
Total contributions received or receivable from participants	2021-12-31	$0
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$158,059
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$-26,259
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$1,585,806
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$1,612,065
Assets. Value of participant loans	2021-12-31	$0
Total contributions received or receivable from employer(s)	2021-12-31	$32,526
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$13,328
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
2020 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2020 401k financial data
Transfers to/from the plan	2020-12-31	$0
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$229,094
Expenses. Total of all expenses incurred	2020-12-31	$253
Benefits paid (including direct rollovers)	2020-12-31	$253
Total plan assets at end of year	2020-12-31	$1,612,065
Total plan assets at beginning of year	2020-12-31	$1,383,224
Value of fidelity bond covering the plan	2020-12-31	$200,000
Total contributions received or receivable from participants	2020-12-31	$0
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$171,788
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$228,841
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$1,612,065
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$1,383,224
Assets. Value of participant loans	2020-12-31	$1,001
Total contributions received or receivable from employer(s)	2020-12-31	$57,306
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$273,555
Expenses. Total of all expenses incurred	2019-12-31	$38,400
Benefits paid (including direct rollovers)	2019-12-31	$38,400
Total plan assets at end of year	2019-12-31	$1,383,224
Total plan assets at beginning of year	2019-12-31	$1,148,069
Value of fidelity bond covering the plan	2019-12-31	$150,000
Total contributions received or receivable from participants	2019-12-31	$0
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$210,960
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$235,155
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$1,383,224
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$1,148,069
Assets. Value of participant loans	2019-12-31	$1,860
Total contributions received or receivable from employer(s)	2019-12-31	$62,595
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2018 401k financial data
Transfers to/from the plan	2018-12-31	$0
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$0
Total income from all sources	2018-12-31	$32,416
Expenses. Total of all expenses incurred	2018-12-31	$39,900
Benefits paid (including direct rollovers)	2018-12-31	$28,726
Total plan assets at end of year	2018-12-31	$1,148,069
Total plan assets at beginning of year	2018-12-31	$1,155,553
Value of fidelity bond covering the plan	2018-12-31	$150,000
Total contributions received or receivable from participants	2018-12-31	$0
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$-12,584
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$-7,484
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$1,148,069
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$1,155,553
Assets. Value of participant loans	2018-12-31	$2,684
Total contributions received or receivable from employer(s)	2018-12-31	$45,000
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$11,174
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2017 401k financial data
Transfers to/from the plan	2017-12-31	$0
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$174,359
Expenses. Total of all expenses incurred	2017-12-31	$14,940
Benefits paid (including direct rollovers)	2017-12-31	$3,000
Total plan assets at end of year	2017-12-31	$1,155,553
Total plan assets at beginning of year	2017-12-31	$996,134
Value of fidelity bond covering the plan	2017-12-31	$150,000
Total contributions received or receivable from participants	2017-12-31	$0
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$110,264
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$159,419
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$1,155,553
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$996,134
Assets. Value of participant loans	2017-12-31	$3,346
Total contributions received or receivable from employer(s)	2017-12-31	$64,095
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$11,940
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$600
Total income from all sources	2016-12-31	$84,141
Expenses. Total of all expenses incurred	2016-12-31	$6,424
Benefits paid (including direct rollovers)	2016-12-31	$0
Total plan assets at end of year	2016-12-31	$996,134
Total plan assets at beginning of year	2016-12-31	$919,017
Value of fidelity bond covering the plan	2016-12-31	$100,000
Total contributions received or receivable from participants	2016-12-31	$0
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$22,172
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$77,717
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$996,134
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$918,417
Assets. Value of participant loans	2016-12-31	$4,194
Total contributions received or receivable from employer(s)	2016-12-31	$61,969
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$6,424
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$600
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$35,550
Expenses. Total of all expenses incurred	2015-12-31	$11,043
Benefits paid (including direct rollovers)	2015-12-31	$3,000
Total plan assets at end of year	2015-12-31	$919,017
Total plan assets at beginning of year	2015-12-31	$893,910
Value of fidelity bond covering the plan	2015-12-31	$100,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-26,180
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$24,507
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$918,417
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$893,910
Total contributions received or receivable from employer(s)	2015-12-31	$61,730
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$8,043
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$67,690
Expenses. Total of all expenses incurred	2014-12-31	$1,945
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$893,910
Total plan assets at beginning of year	2014-12-31	$828,165
Value of fidelity bond covering the plan	2014-12-31	$100,000
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$6,756
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$65,745
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$893,910
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$828,165
Total contributions received or receivable from employer(s)	2014-12-31	$60,934
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$1,945
2013 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$167,859
Expenses. Total of all expenses incurred	2013-12-31	$0
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$828,165
Total plan assets at beginning of year	2013-12-31	$660,306
Value of fidelity bond covering the plan	2013-12-31	$100,000
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$105,092
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$167,859
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$828,165
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$660,306
Total contributions received or receivable from employer(s)	2013-12-31	$62,767
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$0
2012 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$118,518
Expenses. Total of all expenses incurred	2012-12-31	$3,466
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$660,306
Total plan assets at beginning of year	2012-12-31	$545,254
Value of fidelity bond covering the plan	2012-12-31	$75,000
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$58,453
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$115,052
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$660,306
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$545,254
Total contributions received or receivable from employer(s)	2012-12-31	$60,065
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$3,466
2011 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$-12,212
Expenses. Total of all expenses incurred	2011-12-31	$45,555
Benefits paid (including direct rollovers)	2011-12-31	$41,801
Total plan assets at end of year	2011-12-31	$545,254
Total plan assets at beginning of year	2011-12-31	$603,021
Value of fidelity bond covering the plan	2011-12-31	$75,000
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-73,564
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-57,767
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$545,254
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$603,021
Total contributions received or receivable from employer(s)	2011-12-31	$61,352
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$3,754
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$95,102
Expenses. Total of all expenses incurred	2010-12-31	$10,734
Benefits paid (including direct rollovers)	2010-12-31	$8,000
Total plan assets at end of year	2010-12-31	$603,021
Total plan assets at beginning of year	2010-12-31	$518,653
Value of fidelity bond covering the plan	2010-12-31	$75,000
Total contributions received or receivable from participants	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$52,622
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$84,368
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$603,021
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$518,653
Total contributions received or receivable from employer(s)	2010-12-31	$42,480
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$2,734
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN

2022: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: JIM BLECHMAN SOLE PROPRIETOR PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )

Policy contract number

5945437

Policy instance

Insurance contract or identification number	5945437
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )

Policy contract number

5945437

Policy instance

Insurance contract or identification number	5945437
Number of Individuals Covered	10
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $298
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $298
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3
Insurance broker name	JOSE SANTIAGO CHING CRPC

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Company Name:	JIM BLECHMAN SOLE PROPRIETOR
Employer identification number (EIN):	953384525
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)