FIRST STATE PEDIATRICS, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN
401k plan membership statisitcs for FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN
| Measure | Date | Value |
|---|
| 2022: FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 22 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 15 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 7 |
| Total of all active and inactive participants | 2022-01-01 | 22 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2022-01-01 | 0 |
| Total participants | 2022-01-01 | 22 |
| Number of participants with account balances | 2022-01-01 | 21 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2022-01-01 | 0 |
| 2021: FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 22 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 17 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 5 |
| Total of all active and inactive participants | 2021-01-01 | 22 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2021-01-01 | 0 |
| Total participants | 2021-01-01 | 22 |
| Number of participants with account balances | 2021-01-01 | 19 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2021-01-01 | 0 |
| 2020: FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 25 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 17 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 5 |
| Total of all active and inactive participants | 2020-01-01 | 22 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2020-01-01 | 0 |
| Total participants | 2020-01-01 | 22 |
| Number of participants with account balances | 2020-01-01 | 17 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2020-01-01 | 0 |
| 2019: FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 20 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 21 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 4 |
| Total of all active and inactive participants | 2019-01-01 | 25 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2019-01-01 | 0 |
| Total participants | 2019-01-01 | 25 |
| Number of participants with account balances | 2019-01-01 | 18 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2019-01-01 | 0 |
| 2018: FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 29 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 16 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 4 |
| Total of all active and inactive participants | 2018-01-01 | 20 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 0 |
| Total participants | 2018-01-01 | 20 |
| Number of participants with account balances | 2018-01-01 | 19 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-01-01 | 0 |
| Measure | Date | Value |
|---|
| 2022 : FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2022 401k financial data |
|---|
| Transfers to/from the plan | 2022-12-31 | $0 |
| Total plan liabilities at end of year | 2022-12-31 | $1 |
| Total plan liabilities at beginning of year | 2022-12-31 | $0 |
| Total income from all sources | 2022-12-31 | $-598,921 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $107,252 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $82,613 |
| Total plan assets at end of year | 2022-12-31 | $3,512,755 |
| Total plan assets at beginning of year | 2022-12-31 | $4,218,927 |
| Value of fidelity bond covering the plan | 2022-12-31 | $500,000 |
| Assets. Value of tangible personal property | 2022-12-31 | $0 |
| Total contributions received or receivable from participants | 2022-12-31 | $146,600 |
| Assets. Value of loans (other than to participants) | 2022-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2022-12-31 | $0 |
| Other income received | 2022-12-31 | $-798,649 |
| Noncash contributions received | 2022-12-31 | $0 |
| Net income (gross income less expenses) | 2022-12-31 | $-706,173 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $3,512,754 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $4,218,927 |
| Assets. Value of participant loans | 2022-12-31 | $0 |
| Assets. Value of assets in partnership/joint-venture interests | 2022-12-31 | $0 |
| Assets. Value of real-estate (other than employer real property) | 2022-12-31 | $0 |
| Assets. Value of employer securities | 2022-12-31 | $0 |
| Assets. Value of employer real property | 2022-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $53,128 |
| Value of certain deemed distributions of participant loans | 2022-12-31 | $0 |
| Value of corrective distributions | 2022-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $24,639 |
| 2021 : FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2021 401k financial data |
|---|
| Transfers to/from the plan | 2021-12-31 | $0 |
| Total plan liabilities at end of year | 2021-12-31 | $0 |
| Total plan liabilities at beginning of year | 2021-12-31 | $1 |
| Total income from all sources | 2021-12-31 | $761,463 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $45,474 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $17,832 |
| Total plan assets at end of year | 2021-12-31 | $4,218,927 |
| Total plan assets at beginning of year | 2021-12-31 | $3,502,939 |
| Value of fidelity bond covering the plan | 2021-12-31 | $500,000 |
| Assets. Value of tangible personal property | 2021-12-31 | $0 |
| Total contributions received or receivable from participants | 2021-12-31 | $158,786 |
| Assets. Value of loans (other than to participants) | 2021-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2021-12-31 | $0 |
| Other income received | 2021-12-31 | $548,488 |
| Noncash contributions received | 2021-12-31 | $0 |
| Net income (gross income less expenses) | 2021-12-31 | $715,989 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $4,218,927 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $3,502,938 |
| Assets. Value of participant loans | 2021-12-31 | $0 |
| Assets. Value of assets in partnership/joint-venture interests | 2021-12-31 | $0 |
| Assets. Value of real-estate (other than employer real property) | 2021-12-31 | $0 |
| Assets. Value of employer securities | 2021-12-31 | $0 |
| Assets. Value of employer real property | 2021-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $54,189 |
| Value of certain deemed distributions of participant loans | 2021-12-31 | $0 |
| Value of corrective distributions | 2021-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $27,642 |
| 2020 : FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2020 401k financial data |
|---|
| Transfers to/from the plan | 2020-12-31 | $0 |
| Total plan liabilities at end of year | 2020-12-31 | $1 |
| Total plan liabilities at beginning of year | 2020-12-31 | $1 |
| Total income from all sources | 2020-12-31 | $687,400 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $37,742 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $16,748 |
| Total plan assets at end of year | 2020-12-31 | $3,502,939 |
| Total plan assets at beginning of year | 2020-12-31 | $2,853,281 |
| Value of fidelity bond covering the plan | 2020-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2020-12-31 | $146,182 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2020-12-31 | $0 |
| Other income received | 2020-12-31 | $485,471 |
| Noncash contributions received | 2020-12-31 | $0 |
| Net income (gross income less expenses) | 2020-12-31 | $649,658 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $3,502,938 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $2,853,280 |
| Assets. Value of participant loans | 2020-12-31 | $2,267 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $55,747 |
| Value of certain deemed distributions of participant loans | 2020-12-31 | $0 |
| Value of corrective distributions | 2020-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $20,994 |
| 2019 : FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2019 401k financial data |
|---|
| Transfers to/from the plan | 2019-12-31 | $0 |
| Total plan liabilities at end of year | 2019-12-31 | $1 |
| Total plan liabilities at beginning of year | 2019-12-31 | $0 |
| Total income from all sources | 2019-12-31 | $671,794 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $47,862 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $29,019 |
| Total plan assets at end of year | 2019-12-31 | $2,853,281 |
| Total plan assets at beginning of year | 2019-12-31 | $2,229,348 |
| Value of fidelity bond covering the plan | 2019-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2019-12-31 | $116,732 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2019-12-31 | $0 |
| Other income received | 2019-12-31 | $497,853 |
| Noncash contributions received | 2019-12-31 | $0 |
| Net income (gross income less expenses) | 2019-12-31 | $623,932 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $2,853,280 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $2,229,348 |
| Assets. Value of participant loans | 2019-12-31 | $5,923 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $57,209 |
| Value of certain deemed distributions of participant loans | 2019-12-31 | $0 |
| Value of corrective distributions | 2019-12-31 | $599 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $18,244 |
| 2018 : FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2018 401k financial data |
|---|
| Transfers to/from the plan | 2018-12-31 | $0 |
| Total plan liabilities at end of year | 2018-12-31 | $0 |
| Total plan liabilities at beginning of year | 2018-12-31 | $0 |
| Total income from all sources | 2018-12-31 | $78,603 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $30,682 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $23,389 |
| Total plan assets at end of year | 2018-12-31 | $2,229,348 |
| Total plan assets at beginning of year | 2018-12-31 | $2,181,427 |
| Value of fidelity bond covering the plan | 2018-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $126,023 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2018-12-31 | $0 |
| Other income received | 2018-12-31 | $-102,910 |
| Noncash contributions received | 2018-12-31 | $0 |
| Net income (gross income less expenses) | 2018-12-31 | $47,921 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $2,229,348 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $2,181,427 |
| Assets. Value of participant loans | 2018-12-31 | $6,510 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $55,490 |
| Value of certain deemed distributions of participant loans | 2018-12-31 | $0 |
| Value of corrective distributions | 2018-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $7,293 |
| 2022: FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021: FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: FIRST STATE PEDIATRICS, LLC 401(K) PROFIT SHARING PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 895543 087 |
| Policy instance | 1 |
| Insurance contract or identification number | 895543 087 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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? | Yes | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 895543 087 |
| Policy instance | 1 |
| Insurance contract or identification number | 895543 087 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 895543 087 |
| Policy instance | 1 |
| Insurance contract or identification number | 895543 087 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 895543087 |
| Policy instance | 1 |
| Insurance contract or identification number | 895543087 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 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? | Yes | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 ) |
| Policy contract number | 91691963 |
| Policy instance | 2 |
| Insurance contract or identification number | 91691963 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 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? | Yes | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 895543087 |
| Policy instance | 1 |
| Insurance contract or identification number | 895543087 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 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 $0 | | Amount paid for insurance broker fees | 0 |
|
| AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 ) |
| Policy contract number | 91691963 |
| Policy instance | 2 |
| Insurance contract or identification number | 91691963 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-09-14 | | Total amount of commissions paid to insurance broker | USD $2,214 | | Total amount of fees paid to insurance company | USD $0 | | 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 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? | Yes | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,107 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
