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CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN 401k Plan overview

Plan NameCALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN
Plan identification number 002

CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN Benefits

401k Plan TypeDefined 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
  • 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.
  • 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

CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION
Employer identification number (EIN):770085614
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022016-01-01
0022015-01-01GREG MORGANROTH
0022014-01-01GREG MORGANROTH2015-06-05
0022013-01-01GREG MORGANROTH2014-06-17
0022012-01-01GREG MORGANROTH2013-07-17
0022011-01-01GREG MORGANROTH2012-10-09
0022010-01-01GREG MORGANROTH2011-09-30

Plan Statistics for CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN

401k plan membership statisitcs for CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN

Measure Date Value
2016: CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01220
Total number of active participants reported on line 7a of the Form 55002016-01-01134
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0176
Total of all active and inactive participants2016-01-01210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01210
Number of participants with account balances2016-01-01210
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-0124
2015: CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01186
Total number of active participants reported on line 7a of the Form 55002015-01-01120
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0170
Total of all active and inactive participants2015-01-01190
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01190
Number of participants with account balances2015-01-01190
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-0136

Financial Data on CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN

Measure Date Value
2016 : CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets2016-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$0
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Expenses. Interest paid2016-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022016-12-31$0
Total income from all sources (including contributions)2016-12-31$1,571,616
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$178,633
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$156,758
Expenses. Certain deemed distributions of participant loans2016-12-31$0
Value of total corrective distributions2016-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,103,062
Value of total assets at end of year2016-12-31$6,949,456
Value of total assets at beginning of year2016-12-31$5,556,473
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$21,875
Total income from rents2016-12-31$0
Total interest from all sources2016-12-31$7,390
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$0
Assets. Real estate other than employer real property at end of year2016-12-31$0
Assets. Real estate other than employer real property at beginning of year2016-12-31$0
Administrative expenses professional fees incurred2016-12-31$21,628
Assets. Corporate prefeered stocks other than exployer securities at end of year2016-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2016-12-31$0
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$546,693
Participant contributions at end of year2016-12-31$70,887
Participant contributions at beginning of year2016-12-31$30,769
Participant contributions at end of year2016-12-31$0
Participant contributions at beginning of year2016-12-31$34
Assets. Other investments not covered elsewhere at end of year2016-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2016-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$1,325
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$1,325
Assets. Loans (other than to participants) at end of year2016-12-31$0
Assets. Loans (other than to participants) at beginning of year2016-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$0
Other income not declared elsewhere2016-12-31$0
Administrative expenses (other) incurred2016-12-31$0
Liabilities. Value of operating payables at end of year2016-12-31$0
Liabilities. Value of operating payables at beginning of year2016-12-31$0
Total non interest bearing cash at end of year2016-12-31$16,831
Total non interest bearing cash at beginning of year2016-12-31$5,340
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Income. Non cash contributions2016-12-31$0
Value of net income/loss2016-12-31$1,392,983
Value of net assets at end of year (total assets less liabilities)2016-12-31$6,949,456
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$5,556,473
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Assets. partnership/joint venture interests at end of year2016-12-31$0
Assets. partnership/joint venture interests at beginning of year2016-12-31$0
Investment advisory and management fees2016-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$6,303,704
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$4,996,852
Value of interest in pooled separate accounts at end of year2016-12-31$0
Value of interest in pooled separate accounts at beginning of year2016-12-31$0
Interest on participant loans2016-12-31$2,094
Income. Interest from loans (other than to participants)2016-12-31$0
Interest earned on other investments2016-12-31$5,296
Income. Interest from US Government securities2016-12-31$0
Income. Interest from corporate debt instruments2016-12-31$0
Value of interest in master investment trust accounts at end of year2016-12-31$0
Value of interest in master investment trust accounts at beginning of year2016-12-31$0
Value of interest in common/collective trusts at end of year2016-12-31$0
Value of interest in common/collective trusts at beginning of year2016-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2016-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2016-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$0
Asset value of US Government securities at end of year2016-12-31$0
Asset value of US Government securities at beginning of year2016-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$0
Net investment gain/loss from pooled separate accounts2016-12-31$461,164
Net investment gain or loss from common/collective trusts2016-12-31$0
Net gain/loss from 103.12 investment entities2016-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Assets. Invements in employer securities at end of year2016-12-31$0
Assets. Invements in employer securities at beginning of year2016-12-31$0
Assets. Value of employer real property at end of year2016-12-31$0
Assets. Value of employer real property at beginning of year2016-12-31$0
Contributions received in cash from employer2016-12-31$556,369
Employer contributions (assets) at end of year2016-12-31$556,709
Employer contributions (assets) at beginning of year2016-12-31$522,153
Income. Dividends from preferred stock2016-12-31$0
Income. Dividends from common stock2016-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$156,758
Asset. Corporate debt instrument preferred debt at end of year2016-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2016-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2016-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2016-12-31$0
Contract administrator fees2016-12-31$247
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2016-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2016-12-31$0
Liabilities. Value of benefit claims payable at end of year2016-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2016-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2016-12-31$0
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Aggregate proceeds on sale of assets2016-12-31$0
Aggregate carrying amount (costs) on sale of assets2016-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2016-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2016-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31SHEA LABAGH DOBBERSTEIN
Accountancy firm EIN2016-12-31942290202
2015 : CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets2015-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$0
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total transfer of assets to this plan2015-12-31$0
Total transfer of assets from this plan2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Expenses. Interest paid2015-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022015-12-31$0
Total income from all sources (including contributions)2015-12-31$990,497
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$502,486
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$487,857
Expenses. Certain deemed distributions of participant loans2015-12-31$0
Value of total corrective distributions2015-12-31$1,552
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,078,851
Value of total assets at end of year2015-12-31$5,556,473
Value of total assets at beginning of year2015-12-31$5,068,462
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$13,077
Total income from rents2015-12-31$0
Total interest from all sources2015-12-31$1,535
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$0
Assets. Real estate other than employer real property at end of year2015-12-31$0
Assets. Real estate other than employer real property at beginning of year2015-12-31$0
Administrative expenses professional fees incurred2015-12-31$12,893
Assets. Corporate prefeered stocks other than exployer securities at end of year2015-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2015-12-31$0
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$467,090
Participant contributions at end of year2015-12-31$30,769
Participant contributions at beginning of year2015-12-31$38,711
Participant contributions at end of year2015-12-31$34
Participant contributions at beginning of year2015-12-31$0
Assets. Other investments not covered elsewhere at end of year2015-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2015-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$89,948
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$1,325
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$1,325
Assets. Loans (other than to participants) at end of year2015-12-31$0
Assets. Loans (other than to participants) at beginning of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$0
Other income not declared elsewhere2015-12-31$4,504
Administrative expenses (other) incurred2015-12-31$0
Liabilities. Value of operating payables at end of year2015-12-31$0
Liabilities. Value of operating payables at beginning of year2015-12-31$0
Total non interest bearing cash at end of year2015-12-31$5,340
Total non interest bearing cash at beginning of year2015-12-31$268
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Income. Non cash contributions2015-12-31$0
Value of net income/loss2015-12-31$488,011
Value of net assets at end of year (total assets less liabilities)2015-12-31$5,556,473
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$5,068,462
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Assets. partnership/joint venture interests at end of year2015-12-31$0
Assets. partnership/joint venture interests at beginning of year2015-12-31$0
Investment advisory and management fees2015-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$4,996,852
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$4,616,517
Value of interest in pooled separate accounts at end of year2015-12-31$0
Value of interest in pooled separate accounts at beginning of year2015-12-31$0
Interest on participant loans2015-12-31$1,535
Income. Interest from loans (other than to participants)2015-12-31$0
Interest earned on other investments2015-12-31$0
Income. Interest from US Government securities2015-12-31$0
Income. Interest from corporate debt instruments2015-12-31$0
Value of interest in master investment trust accounts at end of year2015-12-31$0
Value of interest in master investment trust accounts at beginning of year2015-12-31$0
Value of interest in common/collective trusts at end of year2015-12-31$0
Value of interest in common/collective trusts at beginning of year2015-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2015-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2015-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$0
Asset value of US Government securities at end of year2015-12-31$0
Asset value of US Government securities at beginning of year2015-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$0
Net investment gain/loss from pooled separate accounts2015-12-31$-94,393
Net investment gain or loss from common/collective trusts2015-12-31$0
Net gain/loss from 103.12 investment entities2015-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Assets. Invements in employer securities at end of year2015-12-31$0
Assets. Invements in employer securities at beginning of year2015-12-31$0
Assets. Value of employer real property at end of year2015-12-31$0
Assets. Value of employer real property at beginning of year2015-12-31$0
Contributions received in cash from employer2015-12-31$521,813
Employer contributions (assets) at end of year2015-12-31$522,153
Employer contributions (assets) at beginning of year2015-12-31$411,641
Income. Dividends from preferred stock2015-12-31$0
Income. Dividends from common stock2015-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$487,857
Asset. Corporate debt instrument preferred debt at end of year2015-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2015-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2015-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2015-12-31$0
Contract administrator fees2015-12-31$184
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2015-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2015-12-31$0
Liabilities. Value of benefit claims payable at end of year2015-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2015-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2015-12-31$0
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Aggregate proceeds on sale of assets2015-12-31$0
Aggregate carrying amount (costs) on sale of assets2015-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2015-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2015-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31SHEA LABAGH DOBBERSTEIN
Accountancy firm EIN2015-12-31942290202

Form 5500 Responses for CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K PROFIT SHARING PLAN

2016: CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K 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: CALIFORNIA SKIN INSTITUTE, A MEDICAL CORPORATION 401K 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

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number83096
Policy instance 1
Insurance contract or identification number83096
Number of Individuals Covered142
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $12,444
Total amount of fees paid to insurance companyUSD $15,408
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees12893
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION
Insurance broker organization code?5
Insurance broker nameBIDWELL CONSULTING SERVICE INC.

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