401k Plan data: ADVANCED ENT plan

ADVANCED ENT 401k Plan overview

Plan Name	ADVANCED ENT
Plan identification number	501

ADVANCED ENT Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

REGIONAL OTOLARYNGOLOGY HEAD AND NECK ASSOCIATES, LLC has sponsored the creation of one or more 401k plans.

Company Name: REGIONAL OTOLARYNGOLOGY HEAD AND NECK ASSOCIATES, LLC

Employer identification number (EIN): 134233377

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ADVANCED ENT

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 SUSAN CARSILLO
501 2014-01-01 PATRICIA MOSER PATRICIA MOSER 2015-06-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2015-01-01	SUSAN CARSILLO
501	2014-01-01	PATRICIA MOSER		PATRICIA MOSER	2015-06-22

Plan Statistics for ADVANCED ENT

401k plan membership statisitcs for ADVANCED ENT

Measure Date Value
2015: ADVANCED ENT 2015 401k membership
Total participants, beginning-of-year 2015-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 27
Total of all active and inactive participants 2015-01-01 27
Total participants 2015-01-01 27
2014: ADVANCED ENT 2014 401k membership
Total participants, beginning-of-year 2014-01-01 60
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 46
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 46
Total participants 2014-01-01 46

Measure	Date	Value
2015: ADVANCED ENT 2015 401k membership
Total participants, beginning-of-year	2015-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	27
Total of all active and inactive participants	2015-01-01	27
Total participants	2015-01-01	27
2014: ADVANCED ENT 2014 401k membership
Total participants, beginning-of-year	2014-01-01	60
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	46
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	46
Total participants	2014-01-01	46

Form 5500 Responses for ADVANCED ENT

2015: ADVANCED ENT 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	First time form 5500 has been submitted	Yes
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: ADVANCED ENT 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	First time form 5500 has been submitted	Yes
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )

Policy contract number

100/5453321

Policy instance

Insurance contract or identification number	100/5453321
Number of Individuals Covered	82
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $184,021
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $12,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,840
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	KAMINER FINANCIAL GROUP, LTC

CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )

Policy contract number

00610582

Policy instance

Insurance contract or identification number	00610582
Number of Individuals Covered	46
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $24,109
Total amount of fees paid to insurance company	USD $8,890
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

Potentially related plans

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Company Name:	REGIONAL OTOLARYNGOLOGY HEAD AND NECK ASSOCIATES, LLC
Employer identification number (EIN):	134233377
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)