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BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 401k Plan overview

Plan NameBRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN
Plan identification number 001

BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN Benefits

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

401k Sponsoring company profile

BRIAN S. KUBO DDS, INC. has sponsored the creation of one or more 401k plans.

Company Name:BRIAN S. KUBO DDS, INC.
Employer identification number (EIN):990333085
NAIC Classification:621210
NAIC Description:Offices of Dentists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01BRIAN KUBO2023-04-01
0012021-01-01BRIAN KUBO2022-03-31
0012020-01-01BRIAN KUBO2021-03-20
0012019-01-01BRIAN KUBO2020-03-23
0012018-01-01BRIAN KUBO2019-04-12
0012017-01-01BRIAN KUBO
0012016-01-01BRIAN KUBO
0012015-01-01BRIAN KUBO
0012014-01-01BRIAN KUBO
0012013-01-01BRIAN S KUBO DDS
0012012-01-01BRIAN S KUBO DDS
0012011-01-01BRIAN S KUBO DDS
0012009-01-01BRIAN S KUBO DDS

Plan Statistics for BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN

Measure Date Value
2017: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-016
Total number of active participants reported on line 7a of the Form 55002017-01-016
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-016
Number of participants with account balances2017-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-015
Total number of active participants reported on line 7a of the Form 55002016-01-016
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-016
Number of participants with account balances2016-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-015
Total number of active participants reported on line 7a of the Form 55002015-01-015
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-015
Number of participants with account balances2015-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-016
Total number of active participants reported on line 7a of the Form 55002014-01-014
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-011
Total of all active and inactive participants2014-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-015
Number of participants with account balances2014-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-011
2013: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-016
Total number of active participants reported on line 7a of the Form 55002013-01-015
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-011
Total of all active and inactive participants2013-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-016
Number of participants with account balances2013-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-017
Total number of active participants reported on line 7a of the Form 55002012-01-016
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-016
Number of participants with account balances2012-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-018
Total number of active participants reported on line 7a of the Form 55002011-01-016
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-011
Total of all active and inactive participants2011-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-017
Number of participants with account balances2011-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-015
Total number of active participants reported on line 7a of the Form 55002009-01-017
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-017
Number of participants with account balances2009-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN

Measure Date Value
2017 : BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$0
Total plan liabilities at beginning of year2017-12-31$0
Total income from all sources2017-12-31$127,458
Expenses. Total of all expenses incurred2017-12-31$10,800
Benefits paid (including direct rollovers)2017-12-31$8,974
Total plan assets at end of year2017-12-31$520,007
Total plan assets at beginning of year2017-12-31$403,349
Value of fidelity bond covering the plan2017-12-31$100,000
Total contributions received or receivable from participants2017-12-31$52,680
Expenses. Other expenses not covered elsewhere2017-12-31$1,826
Contributions received from other sources (not participants or employers)2017-12-31$0
Other income received2017-12-31$60,302
Noncash contributions received2017-12-31$0
Net income (gross income less expenses)2017-12-31$116,658
Net plan assets at end of year (total assets less liabilities)2017-12-31$520,007
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$403,349
Assets. Value of assets in partnership/joint-venture interests2017-12-31$0
Total contributions received or receivable from employer(s)2017-12-31$14,476
Value of certain deemed distributions of participant loans2017-12-31$0
Value of corrective distributions2017-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$0
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$15,020
Expenses. Total of all expenses incurred2016-12-31$0
Benefits paid (including direct rollovers)2016-12-31$0
Total plan assets at end of year2016-12-31$403,349
Total plan assets at beginning of year2016-12-31$388,329
Value of fidelity bond covering the plan2016-12-31$100,000
Total contributions received or receivable from participants2016-12-31$0
Contributions received from other sources (not participants or employers)2016-12-31$0
Other income received2016-12-31$15,020
Net income (gross income less expenses)2016-12-31$15,020
Net plan assets at end of year (total assets less liabilities)2016-12-31$403,349
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$388,329
Assets. Value of assets in partnership/joint-venture interests2016-12-31$12,835
Total contributions received or receivable from employer(s)2016-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$0
2015 : BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$-10,779
Expenses. Total of all expenses incurred2015-12-31$9,609
Benefits paid (including direct rollovers)2015-12-31$9,559
Total plan assets at end of year2015-12-31$388,329
Total plan assets at beginning of year2015-12-31$408,717
Value of fidelity bond covering the plan2015-12-31$100,000
Total contributions received or receivable from participants2015-12-31$0
Contributions received from other sources (not participants or employers)2015-12-31$0
Other income received2015-12-31$-10,779
Net income (gross income less expenses)2015-12-31$-20,388
Net plan assets at end of year (total assets less liabilities)2015-12-31$388,329
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$408,717
Assets. Value of assets in partnership/joint-venture interests2015-12-31$15,136
Total contributions received or receivable from employer(s)2015-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$50
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$3,243
Expenses. Total of all expenses incurred2014-12-31$11,271
Benefits paid (including direct rollovers)2014-12-31$11,221
Total plan assets at end of year2014-12-31$408,717
Total plan assets at beginning of year2014-12-31$416,745
Value of fidelity bond covering the plan2014-12-31$100,000
Total contributions received or receivable from participants2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$3,243
Net income (gross income less expenses)2014-12-31$-8,028
Net plan assets at end of year (total assets less liabilities)2014-12-31$408,717
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$416,745
Assets. Value of assets in partnership/joint-venture interests2014-12-31$16,698
Total contributions received or receivable from employer(s)2014-12-31$0
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$50
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$95,941
Expenses. Total of all expenses incurred2013-12-31$389
Benefits paid (including direct rollovers)2013-12-31$0
Total plan assets at end of year2013-12-31$416,745
Total plan assets at beginning of year2013-12-31$321,193
Value of fidelity bond covering the plan2013-12-31$100,000
Total contributions received or receivable from participants2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$80,941
Net income (gross income less expenses)2013-12-31$95,552
Net plan assets at end of year (total assets less liabilities)2013-12-31$416,745
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$321,193
Assets. Value of assets in partnership/joint-venture interests2013-12-31$14,515
Total contributions received or receivable from employer(s)2013-12-31$15,000
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$389
2012 : BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-12-31$45,772
Expenses. Total of all expenses incurred2012-12-31$1,159
Total plan assets at end of year2012-12-31$321,193
Total plan assets at beginning of year2012-12-31$276,580
Value of fidelity bond covering the plan2012-12-31$100,000
Total contributions received or receivable from participants2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$28,272
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$44,613
Net plan assets at end of year (total assets less liabilities)2012-12-31$321,193
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$276,580
Assets. Value of assets in partnership/joint-venture interests2012-12-31$13,972
Total contributions received or receivable from employer(s)2012-12-31$17,500
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$1,159
2011 : BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$-6,539
Expenses. Total of all expenses incurred2011-12-31$75
Benefits paid (including direct rollovers)2011-12-31$75
Total plan assets at end of year2011-12-31$276,580
Total plan assets at beginning of year2011-12-31$283,194
Value of fidelity bond covering the plan2011-12-31$100,000
Other income received2011-12-31$-18,539
Net income (gross income less expenses)2011-12-31$-6,614
Net plan assets at end of year (total assets less liabilities)2011-12-31$276,580
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$283,194
Assets. Value of assets in partnership/joint-venture interests2011-12-31$15,642
Total contributions received or receivable from employer(s)2011-12-31$12,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$75
2010 : BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$43,975
Expenses. Total of all expenses incurred2010-12-31$0
Benefits paid (including direct rollovers)2010-12-31$0
Total plan assets at end of year2010-12-31$283,194
Total plan assets at beginning of year2010-12-31$239,219
Value of fidelity bond covering the plan2010-12-31$100,000
Total contributions received or receivable from participants2010-12-31$0
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$27,975
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$43,975
Net plan assets at end of year (total assets less liabilities)2010-12-31$283,194
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$239,219
Assets. Value of assets in partnership/joint-venture interests2010-12-31$16,232
Total contributions received or receivable from employer(s)2010-12-31$16,000
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$0

Form 5500 Responses for BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN

2017: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: BRIAN S. KUBO DDS, INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
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

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )
Policy contract number343152-000
Policy instance 1
Insurance contract or identification number343152-000
Number of Individuals Covered6
Insurance policy start date2017-04-19
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,391
Total amount of fees paid to insurance companyUSD $544
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 $1,391
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameHICKS PENSION SERVICES - HI
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number110373EV2
Policy instance 2
Insurance contract or identification number110373EV2
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $341
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
Commission paid to Insurance BrokerUSD $341
Insurance broker organization code?3
Insurance broker nameRAYMOND JAMES INSURANCE GROUP INC
ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC199437-0W
Policy instance 1
Insurance contract or identification numberC199437-0W
Number of Individuals Covered1
Insurance policy start date2014-06-20
Insurance policy end date2015-06-19
Total amount of commissions paid to insurance brokerUSD $376
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
Commission paid to Insurance BrokerUSD $376
Insurance broker organization code?3
Insurance broker nameRAYMOND JAMES FINANCIAL SERVICES
ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC199437-0W
Policy instance 1
Insurance contract or identification numberC199437-0W
Number of Individuals Covered1
Insurance policy start date2013-06-20
Insurance policy end date2014-06-19
Total amount of commissions paid to insurance brokerUSD $375
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
Commission paid to Insurance BrokerUSD $375
Insurance broker organization code?3
Insurance broker nameRAYMOND JAMES FINANCIAL SERVICES
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number110373EV2
Policy instance 2
Insurance contract or identification number110373EV2
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $332
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
Commission paid to Insurance BrokerUSD $304
Insurance broker organization code?3
Insurance broker nameRAYMOND JAMES INSURANCE GROUP INC
ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC199437-0W
Policy instance 2
Insurance contract or identification numberC199437-0W
Number of Individuals Covered1
Insurance policy start date2012-06-20
Insurance policy end date2013-06-19
Total amount of commissions paid to insurance brokerUSD $335
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
Commission paid to Insurance BrokerUSD $335
Insurance broker organization code?3
Insurance broker nameNAOMI Y OYE
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number110373EV2
Policy instance 1
Insurance contract or identification number110373EV2
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $284
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
Commission paid to Insurance BrokerUSD $284
Insurance broker organization code?3
Insurance broker namePLANNING CORP OF AMERICA
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number110373EV2
Policy instance 1
Insurance contract or identification number110373EV2
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
Insurance broker organization code?3
Insurance broker nameNAOMI Y OYE
ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC199437-0W
Policy instance 2
Insurance contract or identification numberC199437-0W
Number of Individuals Covered1
Insurance policy start date2011-06-20
Insurance policy end date2012-06-19
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
Insurance broker organization code?3
Insurance broker nameNAOMI Y OYE
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number110373EV2
Policy instance 1
Insurance contract or identification number110373EV2
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC199437-0W
Policy instance 2
Insurance contract or identification numberC199437-0W
Number of Individuals Covered1
Insurance policy start date2010-06-20
Insurance policy end date2011-06-19
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
ING USA ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberC199437-0W
Policy instance 2
Insurance contract or identification numberC199437-0W
Number of Individuals Covered1
Insurance policy start date2009-06-20
Insurance policy end date2010-06-19
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
Insurance broker organization code?3
Insurance broker nameNAOMI Y OYE
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract number110373EV2
Policy instance 1
Insurance contract or identification number110373EV2
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractINDIVIDUAL ANNUITY CONTRACT
Insurance broker organization code?3
Insurance broker nameNAOMI Y OYE

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