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SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 401k Plan overview

Plan NameSECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN
Plan identification number 001

SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN Benefits

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

401k Sponsoring company profile

SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT has sponsored the creation of one or more 401k plans.

Company Name:SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT
Employer identification number (EIN):020692322
NAIC Classification:541700

Additional information about SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT

Jurisdiction of Incorporation: California Department of State
Incorporation Date: 2003-05-22
Company Identification Number: C2536744
Legal Registered Office Address: 12744 San Fernando Road, Bldg. 3

Sylmar
United States of America (USA)
91342

More information about SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01EDWARD SEDO2023-07-13
0012021-01-01
0012021-01-01
0012020-01-01
0012020-01-01
0012019-01-01
0012019-01-01
0012018-01-01
0012017-01-01JOHN BLAKE
0012016-01-01TOM MILLER
0012015-01-01TOM MILLER
0012015-01-01
0012014-01-01ROBERT GREENBERG2015-07-22
0012013-01-01ROBERT GREENBERG2014-07-03
0012012-01-01ROBERT GREENBERG2013-07-03
0012011-01-01ROBERT GREENBERG2012-08-30
0012010-01-01ROBERT GREENBERG2011-04-19

Plan Statistics for SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN

401k plan membership statisitcs for SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN

Measure Date Value
2021: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01124
Total number of active participants reported on line 7a of the Form 55002021-01-0116
Number of retired or separated participants receiving benefits2021-01-0170
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0186
Number of participants with account balances2021-01-0186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01173
Total number of active participants reported on line 7a of the Form 55002020-01-0113
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-01111
Total of all active and inactive participants2020-01-01124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01124
Number of participants with account balances2020-01-01123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-018
2019: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01187
Total number of active participants reported on line 7a of the Form 55002019-01-01102
Number of retired or separated participants receiving benefits2019-01-0169
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01171
Number of participants with account balances2019-01-01170
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-015
2018: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01177
Total number of active participants reported on line 7a of the Form 55002018-01-01107
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0180
Total of all active and inactive participants2018-01-01187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01187
Number of participants with account balances2018-01-01185
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-015
2017: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01122
Total number of active participants reported on line 7a of the Form 55002017-01-0192
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0184
Total of all active and inactive participants2017-01-01176
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01176
Number of participants with account balances2017-01-01176
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-013
2016: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01144
Total number of active participants reported on line 7a of the Form 55002016-01-0191
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0131
Total of all active and inactive participants2016-01-01122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01122
Number of participants with account balances2016-01-01120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-013
2015: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01134
Total number of active participants reported on line 7a of the Form 55002015-01-01104
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0140
Total of all active and inactive participants2015-01-01144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01144
Number of participants with account balances2015-01-01141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-014

Financial Data on SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN

Measure Date Value
2021 : SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$1,219,578
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$1,660,890
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,658,251
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$198,738
Value of total assets at end of year2021-12-31$9,647,751
Value of total assets at beginning of year2021-12-31$10,089,063
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$2,639
Total interest from all sources2021-12-31$2,549
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$2,639
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$161,654
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$0
Assets. Loans (other than to participants) at end of year2021-12-31$87,784
Assets. Loans (other than to participants) at beginning of year2021-12-31$82,637
Other income not declared elsewhere2021-12-31$34
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-441,312
Value of net assets at end of year (total assets less liabilities)2021-12-31$9,647,751
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$10,089,063
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$0
Value of interest in pooled separate accounts at end of year2021-12-31$9,559,967
Value of interest in pooled separate accounts at beginning of year2021-12-31$10,006,426
Income. Interest from loans (other than to participants)2021-12-31$2,549
Net investment gain/loss from pooled separate accounts2021-12-31$1,018,257
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$37,084
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,658,251
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Disclaimer
Accountancy firm name2021-12-31BPM LLP
Accountancy firm EIN2021-12-31814234542
2020 : SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$1,509,860
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$3,174,628
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$3,151,384
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$549,528
Value of total assets at end of year2020-12-31$10,092,274
Value of total assets at beginning of year2020-12-31$11,757,042
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$23,244
Total interest from all sources2020-12-31$8,247
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$23,244
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$457,966
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$27,760
Assets. Loans (other than to participants) at end of year2020-12-31$82,637
Assets. Loans (other than to participants) at beginning of year2020-12-31$185,855
Other income not declared elsewhere2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-1,664,768
Value of net assets at end of year (total assets less liabilities)2020-12-31$10,092,274
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$11,757,042
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$0
Value of interest in pooled separate accounts at end of year2020-12-31$10,006,426
Value of interest in pooled separate accounts at beginning of year2020-12-31$11,537,295
Income. Interest from loans (other than to participants)2020-12-31$8,247
Net investment gain/loss from pooled separate accounts2020-12-31$952,085
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$91,562
Employer contributions (assets) at end of year2020-12-31$3,211
Employer contributions (assets) at beginning of year2020-12-31$6,132
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$3,151,384
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31BPM LLP
Accountancy firm EIN2020-12-31814234542
2019 : SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$3,258,542
Total income from all sources (including contributions)2019-12-31$3,258,542
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$1,835,125
Total of all expenses incurred2019-12-31$1,835,125
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$1,818,425
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$1,818,425
Expenses. Certain deemed distributions of participant loans2019-12-31$5,467
Expenses. Certain deemed distributions of participant loans2019-12-31$5,467
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,334,887
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,334,887
Value of total assets at end of year2019-12-31$11,716,195
Value of total assets at end of year2019-12-31$11,716,195
Value of total assets at beginning of year2019-12-31$10,292,778
Value of total assets at beginning of year2019-12-31$10,292,778
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$11,233
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$11,233
Total interest from all sources2019-12-31$8,651
Total interest from all sources2019-12-31$8,651
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$1,102,898
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$1,102,898
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$1,102,898
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$1,102,898
Administrative expenses professional fees incurred2019-12-31$11,233
Administrative expenses professional fees incurred2019-12-31$11,233
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$916,772
Contributions received from participants2019-12-31$916,772
Participant contributions at end of year2019-12-31$27,760
Participant contributions at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$237,730
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$237,730
Assets. Loans (other than to participants) at end of year2019-12-31$180,776
Assets. Loans (other than to participants) at end of year2019-12-31$180,776
Assets. Loans (other than to participants) at beginning of year2019-12-31$105,957
Assets. Loans (other than to participants) at beginning of year2019-12-31$105,957
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$1,423,417
Value of net income/loss2019-12-31$1,423,417
Value of net assets at end of year (total assets less liabilities)2019-12-31$11,716,195
Value of net assets at end of year (total assets less liabilities)2019-12-31$11,716,195
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$10,292,778
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$10,292,778
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$11,510,661
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$11,510,661
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$9,815,285
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$9,815,285
Value of interest in pooled separate accounts at end of year2019-12-31$11,537,295
Value of interest in pooled separate accounts at beginning of year2019-12-31$0
Interest on participant loans2019-12-31$8,651
Interest on participant loans2019-12-31$8,651
Value of interest in common/collective trusts at end of year2019-12-31$24,758
Value of interest in common/collective trusts at end of year2019-12-31$24,758
Value of interest in common/collective trusts at beginning of year2019-12-31$371,536
Value of interest in common/collective trusts at beginning of year2019-12-31$371,536
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$744,630
Net investment gain/loss from pooled separate accounts2019-12-31$1,914,165
Net investment gain or loss from common/collective trusts2019-12-31$67,476
Net investment gain or loss from common/collective trusts2019-12-31$67,476
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$180,385
Contributions received in cash from employer2019-12-31$180,385
Employer contributions (assets) at end of year2019-12-31$6,132
Employer contributions (assets) at beginning of year2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$1,818,425
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$1,818,425
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31GUMBINER SAVETT INC.
Accountancy firm name2019-12-31GUMBINER SAVETT INC.
Accountancy firm EIN2019-12-31952875688
Accountancy firm EIN2019-12-31952875688
2018 : SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$989,006
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$431,171
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$419,817
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$1,783,128
Value of total assets at end of year2018-12-31$10,292,778
Value of total assets at beginning of year2018-12-31$9,734,943
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$11,354
Total interest from all sources2018-12-31$5,995
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$631,960
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$631,960
Administrative expenses professional fees incurred2018-12-31$11,354
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$966,292
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$619,179
Assets. Loans (other than to participants) at end of year2018-12-31$105,957
Assets. Loans (other than to participants) at beginning of year2018-12-31$97,568
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$557,835
Value of net assets at end of year (total assets less liabilities)2018-12-31$10,292,778
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$9,734,943
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$9,815,285
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$9,530,417
Interest on participant loans2018-12-31$5,995
Value of interest in common/collective trusts at end of year2018-12-31$371,536
Value of interest in common/collective trusts at beginning of year2018-12-31$106,958
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-1,432,077
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$197,657
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$419,817
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31GUMBINER SAVETT INC.
Accountancy firm EIN2018-12-31952875688
2017 : SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$2,444,717
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$636,938
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$630,443
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$1,156,241
Value of total assets at end of year2017-12-31$9,734,943
Value of total assets at beginning of year2017-12-31$7,927,164
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$6,495
Total interest from all sources2017-12-31$5,601
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$439,265
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$439,265
Administrative expenses professional fees incurred2017-12-31$6,495
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$782,789
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$215,555
Assets. Loans (other than to participants) at end of year2017-12-31$97,568
Assets. Loans (other than to participants) at beginning of year2017-12-31$128,337
Other income not declared elsewhere2017-12-31$219
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$1,807,779
Value of net assets at end of year (total assets less liabilities)2017-12-31$9,734,943
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$7,927,164
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$9,530,417
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$7,731,242
Interest on participant loans2017-12-31$5,601
Value of interest in common/collective trusts at end of year2017-12-31$106,958
Value of interest in common/collective trusts at beginning of year2017-12-31$67,585
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$843,391
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$157,897
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$630,443
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31FARBER HASS HURLEY LLP
Accountancy firm EIN2017-12-31204207759
2016 : SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$1,369,262
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$1,026,169
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$1,018,500
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$914,069
Value of total assets at end of year2016-12-31$7,927,164
Value of total assets at beginning of year2016-12-31$7,584,071
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$7,669
Total interest from all sources2016-12-31$6,131
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$258,063
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$258,063
Administrative expenses professional fees incurred2016-12-31$7,669
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$726,313
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$41,909
Assets. Loans (other than to participants) at end of year2016-12-31$128,337
Assets. Loans (other than to participants) at beginning of year2016-12-31$131,709
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$343,093
Value of net assets at end of year (total assets less liabilities)2016-12-31$7,927,164
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$7,584,071
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$7,731,242
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$7,388,067
Interest on participant loans2016-12-31$6,131
Value of interest in common/collective trusts at end of year2016-12-31$67,585
Value of interest in common/collective trusts at beginning of year2016-12-31$64,295
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$190,999
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$145,847
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$1,018,500
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31FARBER HASS HURLEY LLP
Accountancy firm EIN2016-12-31204207759
2015 : SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$757,598
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$788,102
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$782,824
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$871,161
Value of total assets at end of year2015-12-31$7,584,071
Value of total assets at beginning of year2015-12-31$7,614,575
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$5,278
Total interest from all sources2015-12-31$9,295
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$320,021
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$320,021
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$734,049
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$2,420
Assets. Loans (other than to participants) at end of year2015-12-31$131,709
Assets. Loans (other than to participants) at beginning of year2015-12-31$200,155
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-30,504
Value of net assets at end of year (total assets less liabilities)2015-12-31$7,584,071
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$7,614,575
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$5,278
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$7,388,067
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$7,363,609
Income. Interest from loans (other than to participants)2015-12-31$9,295
Value of interest in common/collective trusts at end of year2015-12-31$64,295
Value of interest in common/collective trusts at beginning of year2015-12-31$50,811
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-442,879
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$134,692
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$782,824
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31FARBER HASS HURLEY LLP
Accountancy firm EIN2015-12-31204207759

Form 5500 Responses for SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN

2021: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS 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 – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS 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: SECOND SIGHT MEDICAL PRODUCTS, INC. DBA SECOND SIGHT 401(K) SAVINGS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedYes
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

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number827197
Policy instance 1
Insurance contract or identification number827197
Number of Individuals Covered86
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $4,912
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees4912
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker organization code?4
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number827197
Policy instance 1
Insurance contract or identification number827197
Number of Individuals Covered123
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $27,447
Total amount of fees paid to insurance companyUSD $5,246
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,447
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADVISORY SERVICES
Insurance broker organization code?4
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number827197
Policy instance 1
Insurance contract or identification number827197
Number of Individuals Covered170
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $21,631
Total amount of fees paid to insurance companyUSD $5,446
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,631
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADVISORY SERVICES
Insurance broker organization code?4
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number827197
Policy instance 1
Insurance contract or identification number827197
Number of Individuals Covered185
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $27,518
Total amount of fees paid to insurance companyUSD $3,961
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,518
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADVISORY SERVICES
Insurance broker organization code?4
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number827197
Policy instance 1
Insurance contract or identification number827197
Number of Individuals Covered176
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $27,979
Total amount of fees paid to insurance companyUSD $5,369
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,979
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADVISORY SERVICES
Insurance broker organization code?4
Insurance broker nameCBIZ RETIREMENT PLAN SERVICES
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number827197
Policy instance 1
Insurance contract or identification number827197
Number of Individuals Covered140
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $20,099
Total amount of fees paid to insurance companyUSD $3,587
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,099
Insurance broker organization code?4
Amount paid for insurance broker fees3587
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameACTUARIAL CONSULTANTS, INC.

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