401k Plan data: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN plan

GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 401k Plan overview

Plan Name	GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN
Plan identification number	001

GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
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.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

GULF COAST FACIAL AND ORAL SURGERY, INC. has sponsored the creation of one or more 401k plans.

Company Name: GULF COAST FACIAL AND ORAL SURGERY, INC.

Employer identification number (EIN): 205136046

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

Additional information about GULF COAST FACIAL AND ORAL SURGERY, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2006-06-21

Company Identification Number: P06000084981

Legal Registered Office Address: 850 South Palafox St

Pensacola

32502

More information about GULF COAST FACIAL AND ORAL SURGERY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 CHADWICK J. MARSHALL, DMD, MD 2023-10-04
001 2021-01-01 CHADWICK J. MARSHALL, DMD, MD 2022-04-18
001 2020-01-01 ERIC M. SCHEUFLER, DMD, MD 2021-10-14
001 2018-01-01 ERIC M. SCHEUFLER, DMD, MD 2019-08-16
001 2017-01-01 ERIC M. SCHEUFLER, DMD, MD 2018-10-14
001 2016-01-01 ERIC M. SCHEUFLER, DMD, MD 2017-04-25
001 2015-01-01 ERIC M. SCHEUFLER, DMD, MD 2016-10-13
001 2014-01-01 ERIC M. SCHEUFLER, DMD, MD 2015-10-14
001 2013-01-01 ERIC M. SCHEUFLER, DMD, MD
001 2012-01-01 ERIC SCHEUFLER
001 2011-01-01 RANDALL W. BROWN
001 2010-01-01 RANDALL W. BROWN
001 2009-01-01 RANDALL W. BROWN
001 2009-01-01
001 2009-01-01 RANDALL W. BROWN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2022-01-01	CHADWICK J. MARSHALL, DMD, MD	2023-10-04
001	2021-01-01	CHADWICK J. MARSHALL, DMD, MD	2022-04-18
001	2020-01-01	ERIC M. SCHEUFLER, DMD, MD	2021-10-14
001	2018-01-01	ERIC M. SCHEUFLER, DMD, MD	2019-08-16
001	2017-01-01	ERIC M. SCHEUFLER, DMD, MD	2018-10-14
001	2016-01-01	ERIC M. SCHEUFLER, DMD, MD	2017-04-25
001	2015-01-01	ERIC M. SCHEUFLER, DMD, MD	2016-10-13
001	2014-01-01	ERIC M. SCHEUFLER, DMD, MD	2015-10-14
001	2013-01-01	ERIC M. SCHEUFLER, DMD, MD
001	2012-01-01	ERIC SCHEUFLER
001	2011-01-01	RANDALL W. BROWN
001	2010-01-01	RANDALL W. BROWN
001	2009-01-01	RANDALL W. BROWN
001	2009-01-01
001	2009-01-01	RANDALL W. BROWN

Plan Statistics for GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN

401k plan membership statisitcs for GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN

Measure Date Value
2013: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 20
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 8
Total of all active and inactive participants 2013-01-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 28
Number of participants with account balances 2013-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 19
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 19
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 6
Total of all active and inactive participants 2012-01-01 25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 25
Number of participants with account balances 2012-01-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 18
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 1
Total of all active and inactive participants 2011-01-01 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 19
Number of participants with account balances 2011-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 22
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 1
Total of all active and inactive participants 2010-01-01 23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 23
Number of participants with account balances 2010-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 21
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 2
Total of all active and inactive participants 2009-01-01 23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 23
Number of participants with account balances 2009-01-01 23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2013: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	20
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	8
Total of all active and inactive participants	2013-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	28
Number of participants with account balances	2013-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	19
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	19
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	6
Total of all active and inactive participants	2012-01-01	25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	25
Number of participants with account balances	2012-01-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	18
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	1
Total of all active and inactive participants	2011-01-01	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	19
Number of participants with account balances	2011-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	22
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	1
Total of all active and inactive participants	2010-01-01	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	23
Number of participants with account balances	2010-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	21
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	2
Total of all active and inactive participants	2009-01-01	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	23
Number of participants with account balances	2009-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN

Measure	Date	Value
2013 : GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$865
Total income from all sources	2013-12-31	$622,100
Expenses. Total of all expenses incurred	2013-12-31	$1,973,324
Benefits paid (including direct rollovers)	2013-12-31	$1,973,324
Total plan assets at end of year	2013-12-31	$1,327,096
Total plan assets at beginning of year	2013-12-31	$2,677,455
Value of fidelity bond covering the plan	2013-12-31	$337,750
Total contributions received or receivable from participants	2013-12-31	$76,455
Other income received	2013-12-31	$433,613
Net income (gross income less expenses)	2013-12-31	$-1,351,224
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,326,231
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,677,455
Assets. Value of participant loans	2013-12-31	$18,863
Total contributions received or receivable from employer(s)	2013-12-31	$112,032
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$70,000
2012 : GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$430,297
Expenses. Total of all expenses incurred	2012-12-31	$18,469
Benefits paid (including direct rollovers)	2012-12-31	$18,469
Total plan assets at end of year	2012-12-31	$2,677,455
Total plan assets at beginning of year	2012-12-31	$2,265,627
Total contributions received or receivable from participants	2012-12-31	$87,638
Other income received	2012-12-31	$223,032
Net income (gross income less expenses)	2012-12-31	$411,828
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,677,455
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,265,627
Assets. Value of participant loans	2012-12-31	$132,855
Assets. Value of real-estate (other than employer real property)	2012-12-31	$70,000
Total contributions received or receivable from employer(s)	2012-12-31	$119,627
2011 : GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$318,135
Expenses. Total of all expenses incurred	2011-12-31	$5,707
Benefits paid (including direct rollovers)	2011-12-31	$5,446
Total plan assets at end of year	2011-12-31	$2,265,627
Total plan assets at beginning of year	2011-12-31	$1,953,199
Total contributions received or receivable from participants	2011-12-31	$84,308
Contributions received from other sources (not participants or employers)	2011-12-31	$65,940
Other income received	2011-12-31	$33,628
Net income (gross income less expenses)	2011-12-31	$312,428
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,265,627
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,953,199
Assets. Value of participant loans	2011-12-31	$96,012
Assets. Value of real-estate (other than employer real property)	2011-12-31	$70,000
Total contributions received or receivable from employer(s)	2011-12-31	$134,259
Value of certain deemed distributions of participant loans	2011-12-31	$261
2010 : GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$396,873
Expenses. Total of all expenses incurred	2010-12-31	$145
Total plan assets at end of year	2010-12-31	$1,953,199
Total plan assets at beginning of year	2010-12-31	$1,556,471
Total contributions received or receivable from participants	2010-12-31	$80,673
Contributions received from other sources (not participants or employers)	2010-12-31	$406
Other income received	2010-12-31	$182,136
Net income (gross income less expenses)	2010-12-31	$396,728
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,953,199
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,556,471
Assets. Value of participant loans	2010-12-31	$96,012
Assets. Value of real-estate (other than employer real property)	2010-12-31	$70,000
Total contributions received or receivable from employer(s)	2010-12-31	$133,658
Value of certain deemed distributions of participant loans	2010-12-31	$145

Form 5500 Responses for GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN

2013: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: GULF COAST FACIAL & ORAL SURGERY, INC. 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	Yes
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

944653-01

Policy instance

Insurance contract or identification number	944653-01
Number of Individuals Covered	24
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $6,444
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?	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,444
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN MUTUAL INVESTMENT SERV

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

944653-01

Policy instance

Insurance contract or identification number	944653-01
Number of Individuals Covered	23
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,170
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?	Yes
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
Commission paid to Insurance Broker	USD $5,170
Insurance broker organization code?	3
Insurance broker name	NORTHWESTERN MUTUAL INVESTMENT SERV

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

76886

Policy instance

Insurance contract or identification number	76886
Number of Individuals Covered	0
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,392
Total amount of fees paid to insurance company	USD $1,060
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

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

76886

Policy instance

Insurance contract or identification number	76886
Number of Individuals Covered	23
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,852
Total amount of fees paid to insurance company	USD $841
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
Commission paid to Insurance Broker	USD $3,852
Insurance broker organization code?	3
Amount paid for insurance broker fees	841
Additional information about fees paid to insurance broker	ADMINISTRATIVE FEES
Insurance broker name	THE PENSION CENTER OF FLORIDA, INC.

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Company Name:	GULF COAST FACIAL AND ORAL SURGERY, INC.
Employer identification number (EIN):	205136046
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2006-06-21
Company Identification Number:	P06000084981
Legal Registered Office Address:	850 South Palafox St Pensacola 32502