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PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 401k Plan overview

Plan NamePREMIER HEALTHCARE MANAGEMENT 401(K) PLAN
Plan identification number 001

PREMIER HEALTHCARE MANAGEMENT 401(K) 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan covering Self-Employed individuals.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

PREMIER HEALTHCARE MANAGEMENT LLC has sponsored the creation of one or more 401k plans.

Company Name:PREMIER HEALTHCARE MANAGEMENT LLC
Employer identification number (EIN):261626826
NAIC Classification:541600

Additional information about PREMIER HEALTHCARE MANAGEMENT LLC

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 2014-03-05
Company Identification Number: 4538722
Legal Registered Office Address: C/O HIGHFIELD GARDENS
199 COMMUNITY DR.
GREAT NECK
United States of America (USA)
11021

More information about PREMIER HEALTHCARE MANAGEMENT LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012019-01-01
0012018-01-01
0012018-01-01
0012017-01-01BARAK BAVER
0012017-01-01BARAK BAVER
0012017-01-01
0012017-01-01
0012016-01-01BARAK BAVER
0012016-01-01
0012015-01-01
0012014-01-01BARAK BAVER2015-09-10

Plan Statistics for PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN

401k plan membership statisitcs for PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN

Measure Date Value
2022: PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01172
Total number of active participants reported on line 7a of the Form 55002022-01-0195
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0114
Total of all active and inactive participants2022-01-01109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01109
Number of participants with account balances2022-01-0154
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01180
Total number of active participants reported on line 7a of the Form 55002021-01-01155
Number of retired or separated participants receiving benefits2021-01-011
Number of other retired or separated participants entitled to future benefits2021-01-0112
Total of all active and inactive participants2021-01-01168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01168
Number of participants with account balances2021-01-0154
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01288
Total number of active participants reported on line 7a of the Form 55002020-01-01300
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0111
Total of all active and inactive participants2020-01-01311
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01311
Number of participants with account balances2020-01-0155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01198
Total number of active participants reported on line 7a of the Form 55002019-01-01181
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0112
Total of all active and inactive participants2019-01-01193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01193
Number of participants with account balances2019-01-0139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01227
Total number of active participants reported on line 7a of the Form 55002018-01-01234
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0112
Total of all active and inactive participants2018-01-01246
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01246
Number of participants with account balances2018-01-0134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01209
Total number of active participants reported on line 7a of the Form 55002017-01-01152
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-013
Total of all active and inactive participants2017-01-01155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01155
Number of participants with account balances2017-01-0127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01133
Total number of active participants reported on line 7a of the Form 55002016-01-01208
Number of retired or separated participants receiving benefits2016-01-011
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01209
Number of participants with account balances2016-01-0128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01159
Total number of active participants reported on line 7a of the Form 55002015-01-01130
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-013
Total of all active and inactive participants2015-01-01133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01133
Number of participants with account balances2015-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010

Financial Data on PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN

Measure Date Value
2022 : PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$507
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-49,682
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$179,438
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$166,718
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$168,613
Value of total assets at end of year2022-12-31$1,001,914
Value of total assets at beginning of year2022-12-31$1,230,527
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$12,720
Total interest from all sources2022-12-31$762
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$59,007
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$59,007
Administrative expenses professional fees incurred2022-12-31$12,720
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$168,613
Participant contributions at end of year2022-12-31$17,098
Participant contributions at beginning of year2022-12-31$21,157
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$507
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$-3,573
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-229,120
Value of net assets at end of year (total assets less liabilities)2022-12-31$1,001,407
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$1,230,527
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$981,919
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$1,152,694
Interest on participant loans2022-12-31$762
Value of interest in common/collective trusts at end of year2022-12-31$0
Value of interest in common/collective trusts at beginning of year2022-12-31$53,770
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$2,897
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$2,906
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-274,491
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$166,718
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
2021 : PREMIER HEALTHCARE MANAGEMENT 401(K) 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$335,935
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$33,889
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$25,152
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$211,027
Value of total assets at end of year2021-12-31$1,230,527
Value of total assets at beginning of year2021-12-31$928,481
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$8,737
Total interest from all sources2021-12-31$559
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$123,448
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$123,448
Administrative expenses professional fees incurred2021-12-31$8,737
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$211,027
Participant contributions at end of year2021-12-31$21,157
Participant contributions at beginning of year2021-12-31$5,938
Other income not declared elsewhere2021-12-31$19
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$302,046
Value of net assets at end of year (total assets less liabilities)2021-12-31$1,230,527
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$928,481
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$1,152,694
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$870,516
Interest on participant loans2021-12-31$559
Value of interest in common/collective trusts at end of year2021-12-31$53,770
Value of interest in common/collective trusts at beginning of year2021-12-31$47,195
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$2,906
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$4,832
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$882
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$25,152
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
2020 : PREMIER HEALTHCARE MANAGEMENT 401(K) 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$408,314
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$35,588
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$7,532
Value of total corrective distributions2020-12-31$22,406
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$284,075
Value of total assets at end of year2020-12-31$928,481
Value of total assets at beginning of year2020-12-31$555,755
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$5,650
Total interest from all sources2020-12-31$397
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$37,437
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$37,437
Administrative expenses professional fees incurred2020-12-31$5,650
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$198,877
Participant contributions at end of year2020-12-31$5,938
Participant contributions at beginning of year2020-12-31$9,550
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$85,198
Other income not declared elsewhere2020-12-31$46
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$372,726
Value of net assets at end of year (total assets less liabilities)2020-12-31$928,481
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$555,755
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$870,516
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$504,769
Interest on participant loans2020-12-31$397
Value of interest in common/collective trusts at end of year2020-12-31$47,195
Value of interest in common/collective trusts at beginning of year2020-12-31$37,555
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$4,832
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$3,881
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$86,359
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 contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$7,532
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
2019 : PREMIER HEALTHCARE MANAGEMENT 401(K) 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$319,181
Total income from all sources (including contributions)2019-12-31$319,181
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$36,473
Total of all expenses incurred2019-12-31$36,473
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$32,344
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$32,344
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$241,534
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$241,534
Value of total assets at end of year2019-12-31$555,755
Value of total assets at end of year2019-12-31$555,755
Value of total assets at beginning of year2019-12-31$273,047
Value of total assets at beginning of year2019-12-31$273,047
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$4,129
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$4,129
Total interest from all sources2019-12-31$389
Total interest from all sources2019-12-31$389
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$30,982
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$30,982
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
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$30,982
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$30,982
Administrative expenses professional fees incurred2019-12-31$4,129
Administrative expenses professional fees incurred2019-12-31$4,129
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$158,454
Contributions received from participants2019-12-31$158,454
Participant contributions at end of year2019-12-31$9,550
Participant contributions at end of year2019-12-31$9,550
Participant contributions at beginning of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Participant contributions at end of year2019-12-31$1,217
Participant contributions at beginning of year2019-12-31$6,079
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$83,080
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$83,080
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$19,565
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other income not declared elsewhere2019-12-31$666
Other income not declared elsewhere2019-12-31$666
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$282,708
Value of net income/loss2019-12-31$282,708
Value of net assets at end of year (total assets less liabilities)2019-12-31$555,755
Value of net assets at end of year (total assets less liabilities)2019-12-31$555,755
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$273,047
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$273,047
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$504,769
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$504,769
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$253,476
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$253,476
Interest on participant loans2019-12-31$389
Interest on participant loans2019-12-31$389
Value of interest in common/collective trusts at end of year2019-12-31$37,555
Value of interest in common/collective trusts at end of year2019-12-31$37,555
Value of interest in common/collective trusts at beginning of year2019-12-31$18,808
Value of interest in common/collective trusts at beginning of year2019-12-31$18,808
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$3,881
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$3,881
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$763
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$763
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$45,610
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$45,610
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$32,344
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$32,344
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
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31WIPFLI, LLP
Accountancy firm EIN2019-12-31390758449
2018 : PREMIER HEALTHCARE MANAGEMENT 401(K) 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$100,461
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$2,096
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$119,674
Value of total assets at end of year2018-12-31$273,047
Value of total assets at beginning of year2018-12-31$174,682
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$2,096
Total interest from all sources2018-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$23,674
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$23,674
Administrative expenses professional fees incurred2018-12-31$2,096
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$113,455
Participant contributions at end of year2018-12-31$6,079
Participant contributions at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$6,219
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$98,365
Value of net assets at end of year (total assets less liabilities)2018-12-31$273,047
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$174,682
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$253,476
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$160,661
Value of interest in pooled separate accounts at end of year2018-12-31$272,284
Value of interest in pooled separate accounts at beginning of year2018-12-31$0
Value of interest in common/collective trusts at end of year2018-12-31$18,808
Value of interest in common/collective trusts at beginning of year2018-12-31$13,678
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$763
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$343
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-42,887
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 contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
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 name2018-12-31PLANTE & MORAN, PLLC
Accountancy firm EIN2018-12-31381357951
2017 : PREMIER HEALTHCARE MANAGEMENT 401(K) 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$98,151
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$26,045
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$23,403
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$76,017
Value of total assets at end of year2017-12-31$174,682
Value of total assets at beginning of year2017-12-31$102,576
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$2,642
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$8,275
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$8,275
Administrative expenses professional fees incurred2017-12-31$2,642
Was this plan covered by a fidelity bond2017-12-31No
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$76,017
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$72,106
Value of net assets at end of year (total assets less liabilities)2017-12-31$174,682
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$102,576
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$160,661
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$93,819
Value of interest in common/collective trusts at end of year2017-12-31$13,678
Value of interest in common/collective trusts at beginning of year2017-12-31$8,494
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$343
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$263
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$13,859
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$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$23,403
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
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 name2017-12-31PLANTE & MORAN, PLLC
Accountancy firm EIN2017-12-31381357951
2016 : PREMIER HEALTHCARE MANAGEMENT 401(K) 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$68,679
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$18,840
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$0
Expenses. Certain deemed distributions of participant loans2016-12-31$17,020
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$65,761
Value of total assets at end of year2016-12-31$102,576
Value of total assets at beginning of year2016-12-31$52,737
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$1,820
Total interest from all sources2016-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$3,217
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$3,217
Administrative expenses professional fees incurred2016-12-31$1,820
Was this plan covered by a fidelity bond2016-12-31No
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$65,761
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$49,839
Value of net assets at end of year (total assets less liabilities)2016-12-31$102,576
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$52,737
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$93,819
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$47,331
Value of interest in common/collective trusts at end of year2016-12-31$8,494
Value of interest in common/collective trusts at beginning of year2016-12-31$5,315
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$263
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$91
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$-299
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$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
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 name2016-12-31PLANTE & MORAN, PLLC
Accountancy firm EIN2016-12-31381357951
2015 : PREMIER HEALTHCARE MANAGEMENT 401(K) 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$54,227
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$20,152
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$19,649
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$55,154
Value of total assets at end of year2015-12-31$52,737
Value of total assets at beginning of year2015-12-31$18,662
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$503
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$3,872
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$3,872
Administrative expenses professional fees incurred2015-12-31$503
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
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$55,154
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$34,075
Value of net assets at end of year (total assets less liabilities)2015-12-31$52,737
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$18,662
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$47,331
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$16,810
Value of interest in common/collective trusts at end of year2015-12-31$5,315
Value of interest in common/collective trusts at beginning of year2015-12-31$1,852
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$91
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-4,799
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$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$19,649
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
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 name2015-12-31PLANTE & MORAN, PLLC
Accountancy firm EIN2015-12-31381357951

Form 5500 Responses for PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN

2022: PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: PREMIER HEALTHCARE MANAGEMENT 401(K) 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: PREMIER HEALTHCARE MANAGEMENT 401(K) 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: PREMIER HEALTHCARE MANAGEMENT 401(K) 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: PREMIER HEALTHCARE MANAGEMENT 401(K) 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: PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedYes
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: PREMIER HEALTHCARE MANAGEMENT 401(K) 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: PREMIER HEALTHCARE MANAGEMENT 401(K) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-834032
Policy instance 1
Insurance contract or identification numberGA-834032
Number of Individuals Covered53
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,509
Total amount of fees paid to insurance companyUSD $291
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 $2,329
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-834032
Policy instance 1
Insurance contract or identification numberGA-834032
Number of Individuals Covered54
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,029
Total amount of fees paid to insurance companyUSD $504
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 $4,029
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-834032
Policy instance 1
Insurance contract or identification numberGA-834032
Number of Individuals Covered55
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $2,389
Total amount of fees paid to insurance companyUSD $298
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 $2,389
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-834032
Policy instance 1
Insurance contract or identification numberGA-834032
Number of Individuals Covered39
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,196
Total amount of fees paid to insurance companyUSD $182
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 $1,196
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-834032
Policy instance 1
Insurance contract or identification numberGA-834032
Number of Individuals Covered34
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $921
Total amount of fees paid to insurance companyUSD $82
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 $921
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-834032
Policy instance 1
Insurance contract or identification numberGA-834032
Number of Individuals Covered27
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $654
Total amount of fees paid to insurance companyUSD $82
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 $579
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
Insurance broker nameMETLIFE SECURITIES INC.
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-834032
Policy instance 1
Insurance contract or identification numberGA-834032
Number of Individuals Covered8
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $154
Total amount of fees paid to insurance companyUSD $19
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?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 $154
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
Amount paid for insurance broker fees19
Insurance broker nameDYATECH, LLC

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