401k Plan data: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN plan

KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 401k Plan overview

Plan Name	KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN
Plan identification number	002

KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
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.
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.

401k Sponsoring company profile

KEY WEST SURGICAL GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: KEY WEST SURGICAL GROUP, INC.

Employer identification number (EIN): 592206188

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01
002 2021-01-01
002 2020-01-01
002 2019-01-01 RHODA SMITH 2020-09-11 RHODA SMITH 2020-09-11
002 2018-01-01 RHODA SMITH 2019-10-07 RHODA SMITH 2019-10-07
002 2017-01-01
002 2016-01-01
002 2015-01-01
002 2014-01-01 MICHAEL KLITENICK
002 2013-01-01 MICHAEL KLITENICK
002 2012-01-01 MICHAEL KLITENICK
002 2011-01-01 MICHAEL KLITENICK
002 2009-01-01 MICHAEL KLITENICK MICHAEL KLITENICK 2010-04-20

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2019-01-01	RHODA SMITH	2020-09-11	RHODA SMITH	2020-09-11
002	2018-01-01	RHODA SMITH	2019-10-07	RHODA SMITH	2019-10-07
002	2017-01-01
002	2016-01-01
002	2015-01-01
002	2014-01-01	MICHAEL KLITENICK
002	2013-01-01	MICHAEL KLITENICK
002	2012-01-01	MICHAEL KLITENICK
002	2011-01-01	MICHAEL KLITENICK
002	2009-01-01	MICHAEL KLITENICK		MICHAEL KLITENICK	2010-04-20

Plan Statistics for KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN

401k plan membership statisitcs for KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN

Measure Date Value
2022: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 5
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 4
Total of all active and inactive participants 2022-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 9
Number of participants with account balances 2022-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 3
2021: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 11
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 1
Total of all active and inactive participants 2021-01-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 12
Number of participants with account balances 2021-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 9
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 3
Total of all active and inactive participants 2020-01-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 12
Number of participants with account balances 2020-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 8
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 2
Total of all active and inactive participants 2019-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 10
Number of participants with account balances 2019-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 6
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 2
Total of all active and inactive participants 2018-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 8
Number of participants with account balances 2018-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 1
2017: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 7
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 3
Total of all active and inactive participants 2017-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 10
Number of participants with account balances 2017-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 2
2016: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 8
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 0
Total of all active and inactive participants 2016-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 8
Number of participants with account balances 2016-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 1
2015: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 8
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 1
Total of all active and inactive participants 2015-01-01 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 9
Number of participants with account balances 2015-01-01 9
2014: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 6
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 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 8
Number of participants with account balances 2014-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 2
2013: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 7
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 0
Total of all active and inactive participants 2013-01-01 7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 7
Number of participants with account balances 2013-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 8
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 0
Total of all active and inactive participants 2012-01-01 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 8
Number of participants with account balances 2012-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 6
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 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 6
Number of participants with account balances 2011-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 7
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 8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 8
Number of participants with account balances 2009-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2022: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	5
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	4
Total of all active and inactive participants	2022-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	9
Number of participants with account balances	2022-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	3
2021: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	11
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	1
Total of all active and inactive participants	2021-01-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	12
Number of participants with account balances	2021-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	9
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	3
Total of all active and inactive participants	2020-01-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	12
Number of participants with account balances	2020-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	8
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	2
Total of all active and inactive participants	2019-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	10
Number of participants with account balances	2019-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	6
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	2
Total of all active and inactive participants	2018-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	8
Number of participants with account balances	2018-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	1
2017: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	7
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	3
Total of all active and inactive participants	2017-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	10
Number of participants with account balances	2017-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	2
2016: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	8
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	0
Total of all active and inactive participants	2016-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	8
Number of participants with account balances	2016-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	1
2015: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	8
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	1
Total of all active and inactive participants	2015-01-01	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	9
Number of participants with account balances	2015-01-01	9
2014: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	6
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	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	8
Number of participants with account balances	2014-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	2
2013: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	7
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	0
Total of all active and inactive participants	2013-01-01	7
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	7
Number of participants with account balances	2013-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	8
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	0
Total of all active and inactive participants	2012-01-01	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	8
Number of participants with account balances	2012-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	6
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	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	6
Number of participants with account balances	2011-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	7
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	8
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	8
Number of participants with account balances	2009-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN

Measure	Date	Value
2022 : KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2022 401k financial data
Total income from all sources	2022-12-31	$-194,528
Expenses. Total of all expenses incurred	2022-12-31	$57,363
Benefits paid (including direct rollovers)	2022-12-31	$56,642
Total plan assets at end of year	2022-12-31	$2,408,077
Total plan assets at beginning of year	2022-12-31	$2,659,968
Value of fidelity bond covering the plan	2022-12-31	$350,000
Total contributions received or receivable from participants	2022-12-31	$104,615
Other income received	2022-12-31	$-450,592
Net income (gross income less expenses)	2022-12-31	$-251,891
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$2,408,077
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$2,659,968
Assets. Value of participant loans	2022-12-31	$13,886
Total contributions received or receivable from employer(s)	2022-12-31	$151,449
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$721
2021 : KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2021 401k financial data
Total income from all sources	2021-12-31	$298,115
Expenses. Total of all expenses incurred	2021-12-31	$180,898
Benefits paid (including direct rollovers)	2021-12-31	$180,282
Total plan assets at end of year	2021-12-31	$2,659,968
Total plan assets at beginning of year	2021-12-31	$2,542,751
Value of fidelity bond covering the plan	2021-12-31	$350,000
Total contributions received or receivable from participants	2021-12-31	$79,748
Other income received	2021-12-31	$190,744
Net income (gross income less expenses)	2021-12-31	$117,217
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$2,659,968
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$2,542,751
Assets. Value of participant loans	2021-12-31	$20,371
Assets. Value of real-estate (other than employer real property)	2021-12-31	$0
Total contributions received or receivable from employer(s)	2021-12-31	$27,623
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$616
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
2020 : KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2020 401k financial data
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$170,196
Expenses. Total of all expenses incurred	2020-12-31	$20,528
Total plan assets at end of year	2020-12-31	$2,542,751
Total plan assets at beginning of year	2020-12-31	$2,393,083
Value of fidelity bond covering the plan	2020-12-31	$350,000
Other income received	2020-12-31	$20,196
Net income (gross income less expenses)	2020-12-31	$149,668
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$2,542,751
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$2,393,083
Assets. Value of participant loans	2020-12-31	$30,709
Assets. Value of real-estate (other than employer real property)	2020-12-31	$0
Total contributions received or receivable from employer(s)	2020-12-31	$150,000
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$20,528
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : KEY WEST SURGICAL GROUP, INC. 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	$0
Total income from all sources	2019-12-31	$369,656
Expenses. Total of all expenses incurred	2019-12-31	$537,970
Benefits paid (including direct rollovers)	2019-12-31	$516,000
Total plan assets at end of year	2019-12-31	$2,393,083
Total plan assets at beginning of year	2019-12-31	$2,561,397
Value of fidelity bond covering the plan	2019-12-31	$350,000
Total contributions received or receivable from participants	2019-12-31	$0
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	$240,656
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$-168,314
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$2,393,083
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$2,561,397
Assets. Value of participant loans	2019-12-31	$31,870
Assets. Value of real-estate (other than employer real property)	2019-12-31	$240,000
Total contributions received or receivable from employer(s)	2019-12-31	$129,000
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$21,970
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : KEY WEST SURGICAL GROUP, INC. 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	$-256,798
Expenses. Total of all expenses incurred	2018-12-31	$67,131
Benefits paid (including direct rollovers)	2018-12-31	$45,181
Total plan assets at end of year	2018-12-31	$2,561,397
Total plan assets at beginning of year	2018-12-31	$2,885,326
Value of fidelity bond covering the plan	2018-12-31	$300,000
Total contributions received or receivable from participants	2018-12-31	$0
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	$-326,798
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$-323,929
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$2,561,397
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$2,885,326
Assets. Value of participant loans	2018-12-31	$38,091
Assets. Value of real-estate (other than employer real property)	2018-12-31	$816,000
Total contributions received or receivable from employer(s)	2018-12-31	$70,000
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	$21,950
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2017 401k financial data
Transfers to/from the plan	2017-12-31	$0
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$258,372
Expenses. Total of all expenses incurred	2017-12-31	$67,836
Benefits paid (including direct rollovers)	2017-12-31	$47,177
Total plan assets at end of year	2017-12-31	$2,885,326
Total plan assets at beginning of year	2017-12-31	$2,694,790
Value of fidelity bond covering the plan	2017-12-31	$300,000
Total contributions received or receivable from participants	2017-12-31	$0
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$212,372
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$190,536
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$2,885,326
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$2,694,790
Assets. Value of participant loans	2017-12-31	$46,777
Total contributions received or receivable from employer(s)	2017-12-31	$46,000
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$20,659
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$208,917
Expenses. Total of all expenses incurred	2016-12-31	$227,786
Benefits paid (including direct rollovers)	2016-12-31	$206,713
Total plan assets at end of year	2016-12-31	$2,694,790
Total plan assets at beginning of year	2016-12-31	$2,713,659
Value of fidelity bond covering the plan	2016-12-31	$300,000
Total contributions received or receivable from participants	2016-12-31	$0
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$166,917
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$-18,869
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$2,694,790
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$2,713,659
Assets. Value of participant loans	2016-12-31	$57,776
Total contributions received or receivable from employer(s)	2016-12-31	$42,000
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$21,073
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$32,401
Expenses. Total of all expenses incurred	2015-12-31	$20,521
Benefits paid (including direct rollovers)	2015-12-31	$1,605
Total plan assets at end of year	2015-12-31	$2,713,659
Total plan assets at beginning of year	2015-12-31	$2,701,779
Value of fidelity bond covering the plan	2015-12-31	$265,000
Total contributions received or receivable from participants	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-564
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$11,880
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$2,713,659
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$2,701,779
Assets. Value of participant loans	2015-12-31	$16,946
Total contributions received or receivable from employer(s)	2015-12-31	$32,965
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$18,916
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$177,791
Expenses. Total of all expenses incurred	2014-12-31	$23,570
Total plan assets at end of year	2014-12-31	$2,701,779
Total plan assets at beginning of year	2014-12-31	$2,547,558
Value of fidelity bond covering the plan	2014-12-31	$265,000
Expenses. Other expenses not covered elsewhere	2014-12-31	$18,570
Other income received	2014-12-31	$167,791
Net income (gross income less expenses)	2014-12-31	$154,221
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$2,701,779
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$2,547,558
Assets. Value of participant loans	2014-12-31	$25,449
Total contributions received or receivable from employer(s)	2014-12-31	$10,000
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$5,000
2013 : KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$249,379
Expenses. Total of all expenses incurred	2013-12-31	$59,337
Benefits paid (including direct rollovers)	2013-12-31	$43,221
Total plan assets at end of year	2013-12-31	$2,547,558
Total plan assets at beginning of year	2013-12-31	$2,357,516
Value of fidelity bond covering the plan	2013-12-31	$265,000
Other income received	2013-12-31	$181,052
Net income (gross income less expenses)	2013-12-31	$190,042
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,547,558
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,357,516
Assets. Value of participant loans	2013-12-31	$38,833
Total contributions received or receivable from employer(s)	2013-12-31	$68,327
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$16,116
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$178,695
Expenses. Total of all expenses incurred	2012-12-31	$31,191
Benefits paid (including direct rollovers)	2012-12-31	$12,500
Total plan assets at end of year	2012-12-31	$2,357,516
Total plan assets at beginning of year	2012-12-31	$2,210,012
Value of fidelity bond covering the plan	2012-12-31	$200,000
Other income received	2012-12-31	$98,564
Net income (gross income less expenses)	2012-12-31	$147,504
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,357,516
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,210,012
Assets. Value of participant loans	2012-12-31	$50,577
Total contributions received or receivable from employer(s)	2012-12-31	$80,131
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$18,691
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2011 401k financial data
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$85,678
Expenses. Total of all expenses incurred	2011-12-31	$34,263
Benefits paid (including direct rollovers)	2011-12-31	$19,404
Total plan assets at end of year	2011-12-31	$2,210,012
Total plan assets at beginning of year	2011-12-31	$2,158,597
Value of fidelity bond covering the plan	2011-12-31	$200,000
Other income received	2011-12-31	$8,878
Net income (gross income less expenses)	2011-12-31	$51,415
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,210,012
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,158,597
Assets. Value of participant loans	2011-12-31	$52,765
Total contributions received or receivable from employer(s)	2011-12-31	$76,800
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$14,859
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$-130,795
Expenses. Total of all expenses incurred	2010-12-31	$18,783
Benefits paid (including direct rollovers)	2010-12-31	$1,155
Total plan assets at end of year	2010-12-31	$2,158,597
Total plan assets at beginning of year	2010-12-31	$2,308,175
Value of fidelity bond covering the plan	2010-12-31	$200,000
Other income received	2010-12-31	$-208,855
Net income (gross income less expenses)	2010-12-31	$-149,578
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,158,597
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,308,175
Assets. Value of participant loans	2010-12-31	$3,809
Total contributions received or receivable from employer(s)	2010-12-31	$78,060
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$17,628
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN

2022: KEY WEST SURGICAL GROUP, INC. 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: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	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: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	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: KEY WEST SURGICAL GROUP, INC. 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 – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: KEY WEST SURGICAL GROUP, INC. 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 – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: KEY WEST SURGICAL GROUP, INC. PROFIT-SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: KEY WEST SURGICAL GROUP, INC. 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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: KEY WEST SURGICAL GROUP, INC. 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: KEY WEST SURGICAL GROUP, INC. 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: KEY WEST SURGICAL GROUP, INC. 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: KEY WEST SURGICAL GROUP, INC. 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: KEY WEST SURGICAL GROUP, INC. 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: KEY WEST SURGICAL GROUP, INC. 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

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

81G065

Policy instance

Insurance contract or identification number	81G065
Number of Individuals Covered	11
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $12,431
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
Amount paid for insurance broker fees	12431
Additional information about fees paid to insurance broker	CASH COMMISSIONS
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

81G065

Policy instance

Insurance contract or identification number	81G065
Number of Individuals Covered	11
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $12,329
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?	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 $12,329
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	CASH COMMISSIONS
Insurance broker organization code?	3

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )

Policy contract number

81G065

Policy instance

Insurance contract or identification number	81G065
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 $912
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?	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
Amount paid for insurance broker fees	912
Additional information about fees paid to insurance broker	CASH COMMISSIONS
Insurance broker organization code?	3

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Company Name:	KEY WEST SURGICAL GROUP, INC.
Employer identification number (EIN):	592206188
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)