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BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 401k Plan overview

Plan NameBRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN
Plan identification number 003

BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • 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.
  • Life insurance

401k Sponsoring company profile

BRUCE A. KLUNZINGER, M.D., P.C. has sponsored the creation of one or more 401k plans.

Company Name:BRUCE A. KLUNZINGER, M.D., P.C.
Employer identification number (EIN):382338131
NAIC Classification:621320
NAIC Description:Offices of Optometrists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032019-01-01BRUCE A. KLUNZINGER MD2019-09-11
0032018-01-01
0032017-01-01
0032016-01-01
0032015-01-01
0032014-01-01BRUCE A KLUNZINGER
0032013-01-01BRUCE A KLUNZINGER
0032012-01-01BRUCE A KLUNZINGER
0032011-01-01BRUCE A KLUNZINGER2012-08-27
0032010-01-01MARYBETH JORGENSEN2011-07-18

Plan Statistics for BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN

401k plan membership statisitcs for BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN

Measure Date Value
2019: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-016
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-010
2018: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-016
Total number of active participants reported on line 7a of the Form 55002018-01-016
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-016
Number of participants with account balances2018-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-016
Total number of active participants reported on line 7a of the Form 55002017-01-016
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-016
Number of participants with account balances2017-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-017
Total number of active participants reported on line 7a of the Form 55002016-01-016
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-016
Number of participants with account balances2016-01-016
2015: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-016
Total number of active participants reported on line 7a of the Form 55002015-01-014
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-011
Total of all active and inactive participants2015-01-015
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-015
Number of participants with account balances2015-01-015
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-016
Total number of active participants reported on line 7a of the Form 55002014-01-015
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-011
Total of all active and inactive participants2014-01-016
Total participants2014-01-016
Number of participants with account balances2014-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-016
Total number of active participants reported on line 7a of the Form 55002013-01-016
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-016
Number of participants with account balances2013-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-016
Total number of active participants reported on line 7a of the Form 55002012-01-016
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-016
Number of participants with account balances2012-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010

Financial Data on BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN

Measure Date Value
2019 : BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources2019-06-26$35,133
Expenses. Total of all expenses incurred2019-06-26$1,044,275
Benefits paid (including direct rollovers)2019-06-26$1,044,275
Total plan assets at end of year2019-06-26$0
Total plan assets at beginning of year2019-06-26$1,009,142
Value of fidelity bond covering the plan2019-06-26$101,100
Total contributions received or receivable from participants2019-06-26$0
Contributions received from other sources (not participants or employers)2019-06-26$0
Other income received2019-06-26$35,133
Net income (gross income less expenses)2019-06-26$-1,009,142
Net plan assets at end of year (total assets less liabilities)2019-06-26$0
Net plan assets at beginning of year (total assets less liabilities)2019-06-26$1,009,142
Total contributions received or receivable from employer(s)2019-06-26$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-06-26$0
2018 : BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources2018-12-31$826
Expenses. Total of all expenses incurred2018-12-31$1,973
Benefits paid (including direct rollovers)2018-12-31$1,973
Total plan assets at end of year2018-12-31$1,009,142
Total plan assets at beginning of year2018-12-31$1,010,289
Value of fidelity bond covering the plan2018-12-31$101,100
Total contributions received or receivable from participants2018-12-31$0
Contributions received from other sources (not participants or employers)2018-12-31$0
Other income received2018-12-31$826
Net income (gross income less expenses)2018-12-31$-1,147
Net plan assets at end of year (total assets less liabilities)2018-12-31$1,009,142
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$1,010,289
Total contributions received or receivable from employer(s)2018-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources2017-12-31$50,290
Expenses. Total of all expenses incurred2017-12-31$1,692
Total plan assets at end of year2017-12-31$1,010,289
Total plan assets at beginning of year2017-12-31$961,691
Value of fidelity bond covering the plan2017-12-31$100,000
Expenses. Other expenses not covered elsewhere2017-12-31$1,692
Other income received2017-12-31$50,290
Net income (gross income less expenses)2017-12-31$48,598
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,010,289
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$961,691
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-12-31$70,642
Expenses. Total of all expenses incurred2016-12-31$1,964
Benefits paid (including direct rollovers)2016-12-31$1,964
Total plan assets at end of year2016-12-31$961,691
Total plan assets at beginning of year2016-12-31$893,013
Value of fidelity bond covering the plan2016-12-31$100,000
Other income received2016-12-31$40,642
Net income (gross income less expenses)2016-12-31$68,678
Net plan assets at end of year (total assets less liabilities)2016-12-31$961,691
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$893,013
Total contributions received or receivable from employer(s)2016-12-31$30,000
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$28,469
Expenses. Total of all expenses incurred2015-12-31$16,984
Benefits paid (including direct rollovers)2015-12-31$16,984
Total plan assets at end of year2015-12-31$893,013
Total plan assets at beginning of year2015-12-31$881,528
Value of fidelity bond covering the plan2015-12-31$100,000
Other income received2015-12-31$13,469
Net income (gross income less expenses)2015-12-31$11,485
Net plan assets at end of year (total assets less liabilities)2015-12-31$893,013
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$881,528
Total contributions received or receivable from employer(s)2015-12-31$15,000
2014 : BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-12-31$29,050
Expenses. Total of all expenses incurred2014-12-31$36,905
Benefits paid (including direct rollovers)2014-12-31$36,905
Total plan assets at end of year2014-12-31$881,528
Total plan assets at beginning of year2014-12-31$889,383
Value of fidelity bond covering the plan2014-12-31$100,000
Other income received2014-12-31$29,050
Net income (gross income less expenses)2014-12-31$-7,855
Net plan assets at end of year (total assets less liabilities)2014-12-31$881,528
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$889,383
Assets. Value of participant loans2014-12-31$13,817
2013 : BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-12-31$85,710
Expenses. Total of all expenses incurred2013-12-31$783
Total plan assets at end of year2013-12-31$889,383
Total plan assets at beginning of year2013-12-31$804,456
Value of fidelity bond covering the plan2013-12-31$100,000
Expenses. Other expenses not covered elsewhere2013-12-31$783
Other income received2013-12-31$59,960
Net income (gross income less expenses)2013-12-31$84,927
Net plan assets at end of year (total assets less liabilities)2013-12-31$889,383
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$804,456
Assets. Value of participant loans2013-12-31$13,817
Total contributions received or receivable from employer(s)2013-12-31$25,750
2012 : BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-12-31$48,089
Expenses. Total of all expenses incurred2012-12-31$573
Total plan assets at end of year2012-12-31$804,456
Total plan assets at beginning of year2012-12-31$756,940
Value of fidelity bond covering the plan2012-12-31$100,000
Expenses. Other expenses not covered elsewhere2012-12-31$573
Other income received2012-12-31$33,089
Net income (gross income less expenses)2012-12-31$47,516
Net plan assets at end of year (total assets less liabilities)2012-12-31$804,456
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$756,940
Total contributions received or receivable from employer(s)2012-12-31$15,000

Form 5500 Responses for BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN

2019: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING 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 filingYes
2019-01-01This return/report is a short plan year return/report (less than 12 months)Yes
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: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING 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: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING 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: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING 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
2014: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: BRUCE A. KLUNZINGER, M.D., P.C. EMPLOYEES PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number7091
Policy instance 1
Insurance contract or identification number7091
Number of Individuals Covered6
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $49
Total amount of fees paid to insurance companyUSD $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 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 BenefitYes
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 $49
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?3
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number7091
Policy instance 1
Insurance contract or identification number7091
Number of Individuals Covered6
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $42
Total amount of fees paid to insurance companyUSD $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 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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27
Insurance broker organization code?3
Insurance broker nameANDREW D. BROGAN
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number7091
Policy instance 1
Insurance contract or identification number7091
Number of Individuals Covered5
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $28
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 BenefitYes
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 $18
Insurance broker organization code?3
Insurance broker nameANDREW D. BROGAN
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number7091
Policy instance 1
Insurance contract or identification number7091
Number of Individuals Covered6
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $636
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 BenefitYes
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 $407
Insurance broker organization code?3
Insurance broker nameANDREW D. BROGAN
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number7091
Policy instance 1
Insurance contract or identification number7091
Number of Individuals Covered6
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $355
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 BenefitYes
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 $227
Insurance broker organization code?3
Insurance broker nameANDREW D. BROGAN
THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 )
Policy contract number7091
Policy instance 1
Insurance contract or identification number7091
Number of Individuals Covered6
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $789
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 BenefitYes
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 $631
Insurance broker organization code?3
Insurance broker nameANDREW D. BROGAN

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