401k Plan data: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN plan

NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN
Plan identification number	001

NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined 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.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

NORTH FULTON EYE CENTER PC has sponsored the creation of one or more 401k plans.

Company Name: NORTH FULTON EYE CENTER PC

Employer identification number (EIN): 581660255

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01
001 2013-01-01
001 2012-01-01 MARK DUNBAR, M.D. MARK DUNBAR, M.D. 2013-08-20
001 2011-01-01 MARK DUNBAR, M.D. MARK DUNBAR, M.D. 2012-07-25
001 2009-01-01 MARK DUNBAR MARK DUNBAR 2010-10-13

Plan Statistics for NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN

Measure Date Value
2016: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 16
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 1
Total of all active and inactive participants 2016-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 17
Number of participants with account balances 2016-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 15
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 2
Total of all active and inactive participants 2015-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 17
Number of participants with account balances 2015-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 14
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 2
Total of all active and inactive participants 2014-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 16
Number of participants with account balances 2014-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 14
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 2
Total of all active and inactive participants 2013-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 16
Number of participants with account balances 2013-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 14
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 1
Total of all active and inactive participants 2012-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 15
Number of participants with account balances 2012-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 16
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 16
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 16
Number of participants with account balances 2011-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 19
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 16
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 1
Total of all active and inactive participants 2009-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 17
Number of participants with account balances 2009-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 2

Measure	Date	Value
2016: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	16
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	1
Total of all active and inactive participants	2016-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	17
Number of participants with account balances	2016-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	15
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	2
Total of all active and inactive participants	2015-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	17
Number of participants with account balances	2015-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	14
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	2
Total of all active and inactive participants	2014-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	16
Number of participants with account balances	2014-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	14
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	2
Total of all active and inactive participants	2013-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	16
Number of participants with account balances	2013-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	14
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	1
Total of all active and inactive participants	2012-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	15
Number of participants with account balances	2012-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	16
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	16
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	16
Number of participants with account balances	2011-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	19
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	16
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	1
Total of all active and inactive participants	2009-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	17
Number of participants with account balances	2009-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	2

Financial Data on NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2016 : NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-12-31	$1,400
Total income from all sources	2016-12-31	$406,287
Expenses. Total of all expenses incurred	2016-12-31	$1,742,772
Benefits paid (including direct rollovers)	2016-12-31	$1,742,547
Total plan assets at end of year	2016-12-31	$1,836,359
Total plan assets at beginning of year	2016-12-31	$3,171,444
Value of fidelity bond covering the plan	2016-12-31	$300,000
Total contributions received or receivable from participants	2016-12-31	$106,057
Contributions received from other sources (not participants or employers)	2016-12-31	$3,386
Other income received	2016-12-31	$258,245
Net income (gross income less expenses)	2016-12-31	$-1,336,485
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,834,959
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$3,171,444
Total contributions received or receivable from employer(s)	2016-12-31	$38,599
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$225
2015 : NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$113,515
Expenses. Total of all expenses incurred	2015-12-31	$89,107
Benefits paid (including direct rollovers)	2015-12-31	$88,957
Total plan assets at end of year	2015-12-31	$3,171,444
Total plan assets at beginning of year	2015-12-31	$3,147,036
Value of fidelity bond covering the plan	2015-12-31	$300,000
Total contributions received or receivable from participants	2015-12-31	$105,017
Other income received	2015-12-31	$-29,584
Net income (gross income less expenses)	2015-12-31	$24,408
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$3,171,444
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$3,147,036
Total contributions received or receivable from employer(s)	2015-12-31	$38,082
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$150
2014 : NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$324,465
Expenses. Total of all expenses incurred	2014-12-31	$92,796
Benefits paid (including direct rollovers)	2014-12-31	$92,696
Total plan assets at end of year	2014-12-31	$3,147,036
Total plan assets at beginning of year	2014-12-31	$2,915,367
Value of fidelity bond covering the plan	2014-12-31	$300,000
Total contributions received or receivable from participants	2014-12-31	$88,488
Other income received	2014-12-31	$206,432
Net income (gross income less expenses)	2014-12-31	$231,669
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$3,147,036
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$2,915,367
Total contributions received or receivable from employer(s)	2014-12-31	$29,545
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$100
2013 : NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$568,392
Expenses. Total of all expenses incurred	2013-12-31	$133,332
Benefits paid (including direct rollovers)	2013-12-31	$133,307
Total plan assets at end of year	2013-12-31	$2,915,367
Total plan assets at beginning of year	2013-12-31	$2,480,307
Value of fidelity bond covering the plan	2013-12-31	$300,000
Total contributions received or receivable from participants	2013-12-31	$87,841
Other income received	2013-12-31	$409,288
Net income (gross income less expenses)	2013-12-31	$435,060
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,915,367
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,480,307
Total contributions received or receivable from employer(s)	2013-12-31	$71,263
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$25
2012 : NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$433,285
Expenses. Total of all expenses incurred	2012-12-31	$74,246
Benefits paid (including direct rollovers)	2012-12-31	$74,196
Total plan assets at end of year	2012-12-31	$2,480,307
Total plan assets at beginning of year	2012-12-31	$2,121,268
Value of fidelity bond covering the plan	2012-12-31	$200,000
Total contributions received or receivable from participants	2012-12-31	$97,191
Other income received	2012-12-31	$262,554
Net income (gross income less expenses)	2012-12-31	$359,039
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,480,307
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,121,268
Total contributions received or receivable from employer(s)	2012-12-31	$73,540
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$50
2011 : NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$171,627
Expenses. Total of all expenses incurred	2011-12-31	$20,636
Benefits paid (including direct rollovers)	2011-12-31	$20,586
Total plan assets at end of year	2011-12-31	$2,121,268
Total plan assets at beginning of year	2011-12-31	$1,970,277
Value of fidelity bond covering the plan	2011-12-31	$200,000
Total contributions received or receivable from participants	2011-12-31	$95,088
Expenses. Other expenses not covered elsewhere	2011-12-31	$50
Other income received	2011-12-31	$3,018
Net income (gross income less expenses)	2011-12-31	$150,991
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,121,268
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,970,277
Total contributions received or receivable from employer(s)	2011-12-31	$73,521
2010 : NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at beginning of year	2010-12-31	$1,000
Total income from all sources	2010-12-31	$394,194
Expenses. Total of all expenses incurred	2010-12-31	$1,436
Benefits paid (including direct rollovers)	2010-12-31	$1,411
Total plan assets at end of year	2010-12-31	$1,970,277
Total plan assets at beginning of year	2010-12-31	$1,578,519
Value of fidelity bond covering the plan	2010-12-31	$200,000
Total contributions received or receivable from participants	2010-12-31	$83,515
Other income received	2010-12-31	$234,210
Net income (gross income less expenses)	2010-12-31	$392,758
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,970,277
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,577,519
Total contributions received or receivable from employer(s)	2010-12-31	$76,469
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$25

Form 5500 Responses for NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN

2016: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: NORTH FULTON EYE CENTER, P.C. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

115927

Policy instance

Insurance contract or identification number	115927
Number of Individuals Covered	13
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $-1,152
Total amount of fees paid to insurance company	USD $5,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $-1,152
Insurance broker organization code?	3
Amount paid for insurance broker fees	5346
Additional information about fees paid to insurance broker	TPA FEES AND OTHER COMPENSATION
Insurance broker name	RETIREMENT PLAN ADMINISTRATORS

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

Policy contract number

115927

Policy instance

Insurance contract or identification number	115927
Number of Individuals Covered	13
Insurance policy start date	2014-12-03
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $16,486
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $16,486
Insurance broker organization code?	3
Insurance broker name	CAPSTONE BENEFITS ADVISORS

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Company Name:	NORTH FULTON EYE CENTER PC
Employer identification number (EIN):	581660255
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01
001	2013-01-01
001	2012-01-01	MARK DUNBAR, M.D.	MARK DUNBAR, M.D.	2013-08-20
001	2011-01-01	MARK DUNBAR, M.D.	MARK DUNBAR, M.D.	2012-07-25
001	2009-01-01	MARK DUNBAR	MARK DUNBAR	2010-10-13