401k Plan data: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN plan

SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 401k Plan overview

Plan Name	SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN
Plan identification number	001

SOUTHERN COLORADO VETERINARY SURGERY 401K 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.
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.
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

SOUTHERN COLORADO VETERINARY SURGERY has sponsored the creation of one or more 401k plans.

Company Name: SOUTHERN COLORADO VETERINARY SURGERY

Employer identification number (EIN): 841333270

NAIC Classification: 541940
NAIC Description: Veterinary Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01 BECKY SMEDRA-MCGRAW 2021-11-01
001 2020-01-01 BECKY SMEDRA-MCGRAW 2021-07-14
001 2019-01-01 BECKY SMEDRA-MCGRAW 2020-07-01
001 2018-01-01 BECKY SMEDRA-MCGRAW 2019-07-09
001 2017-01-01 BECKY SMEDRA-MCGRAW 2018-09-13
001 2016-01-01 BECKY SMEDRA-MCGRAW
001 2015-01-01 BECKY SMEDRA-MCGRAW
001 2014-01-01 BECKY SMEDRA-MCGRAW
001 2013-01-01 BECKY SMEDRA-MCGRAW
001 2012-01-01 BECKY SMEDRA-MCGRAW 2013-09-18
001 2011-01-01 BECKY SMEDRA-MCGRAW 2012-06-08
001 2009-01-01 BECKY SMEDRA-MCGRAW
001 2009-01-01 BECKY SMEDRA-MCGRAW
001 2009-01-01 BECKY SMEDRA-MCGRAW
001 2007-01-01 BECKY SMEDRA-MCGRAW BECKY SMEDRA-MCGRAW 2010-03-30

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-01-01	BECKY SMEDRA-MCGRAW	2021-11-01
001	2020-01-01	BECKY SMEDRA-MCGRAW	2021-07-14
001	2019-01-01	BECKY SMEDRA-MCGRAW	2020-07-01
001	2018-01-01	BECKY SMEDRA-MCGRAW	2019-07-09
001	2017-01-01	BECKY SMEDRA-MCGRAW	2018-09-13
001	2016-01-01	BECKY SMEDRA-MCGRAW
001	2015-01-01	BECKY SMEDRA-MCGRAW
001	2014-01-01	BECKY SMEDRA-MCGRAW
001	2013-01-01	BECKY SMEDRA-MCGRAW
001	2012-01-01	BECKY SMEDRA-MCGRAW	2013-09-18
001	2011-01-01	BECKY SMEDRA-MCGRAW	2012-06-08
001	2009-01-01	BECKY SMEDRA-MCGRAW
001	2009-01-01	BECKY SMEDRA-MCGRAW
001	2009-01-01	BECKY SMEDRA-MCGRAW
001	2007-01-01	BECKY SMEDRA-MCGRAW		BECKY SMEDRA-MCGRAW	2010-03-30

Plan Statistics for SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN

401k plan membership statisitcs for SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN

Measure Date Value
2016: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 41
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 29
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 14
Total of all active and inactive participants 2016-01-01 43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 43
Number of participants with account balances 2016-01-01 43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 3
2015: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 35
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 25
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 15
Total of all active and inactive participants 2015-01-01 40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 40
Number of participants with account balances 2015-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 4
2014: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 25
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 10
Total of all active and inactive participants 2014-01-01 35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 35
Number of participants with account balances 2014-01-01 35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 5
2013: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 22
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 7
Total of all active and inactive participants 2013-01-01 29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 29
Number of participants with account balances 2013-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2009: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 16
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 19
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 3
Total of all active and inactive participants 2009-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 22
Number of participants with account balances 2009-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0
2007: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2007 401k membership
Total participants, beginning-of-year 2007-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 11
Number of retired or separated participants receiving benefits 2007-01-01 0
Number of other retired or separated participants entitled to future benefits 2007-01-01 5
Total of all active and inactive participants 2007-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2007-01-01 0
Total participants 2007-01-01 16
Number of participants with account balances 2007-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2007-01-01 0

Measure	Date	Value
2016: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	41
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	29
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	14
Total of all active and inactive participants	2016-01-01	43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	43
Number of participants with account balances	2016-01-01	43
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	3
2015: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	35
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	25
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	15
Total of all active and inactive participants	2015-01-01	40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	40
Number of participants with account balances	2015-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	4
2014: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	25
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	10
Total of all active and inactive participants	2014-01-01	35
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	35
Number of participants with account balances	2014-01-01	35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	5
2013: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	22
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	7
Total of all active and inactive participants	2013-01-01	29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	29
Number of participants with account balances	2013-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2009: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	16
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	19
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	3
Total of all active and inactive participants	2009-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	22
Number of participants with account balances	2009-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0
2007: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	11
Number of retired or separated participants receiving benefits	2007-01-01	0
Number of other retired or separated participants entitled to future benefits	2007-01-01	5
Total of all active and inactive participants	2007-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2007-01-01	0
Total participants	2007-01-01	16
Number of participants with account balances	2007-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2007-01-01	0

Financial Data on SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN

Measure	Date	Value
2016 : SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2016 401k financial data
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	$294,438
Expenses. Total of all expenses incurred	2016-12-31	$143,090
Benefits paid (including direct rollovers)	2016-12-31	$142,966
Total plan assets at end of year	2016-12-31	$2,177,308
Total plan assets at beginning of year	2016-12-31	$2,025,960
Value of fidelity bond covering the plan	2016-12-31	$275,000
Total contributions received or receivable from participants	2016-12-31	$78,783
Other income received	2016-12-31	$149,888
Net income (gross income less expenses)	2016-12-31	$151,348
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$2,177,308
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$2,025,960
Assets. Value of participant loans	2016-12-31	$590
Total contributions received or receivable from employer(s)	2016-12-31	$65,767
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$124
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2015 401k financial data
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	$106,519
Expenses. Total of all expenses incurred	2015-12-31	$12,782
Benefits paid (including direct rollovers)	2015-12-31	$12,561
Total plan assets at end of year	2015-12-31	$2,025,960
Total plan assets at beginning of year	2015-12-31	$1,932,223
Value of fidelity bond covering the plan	2015-12-31	$275,000
Total contributions received or receivable from participants	2015-12-31	$90,686
Other income received	2015-12-31	$-32,296
Net income (gross income less expenses)	2015-12-31	$93,737
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$2,025,960
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,932,223
Assets. Value of participant loans	2015-12-31	$2,825
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2015-12-31	$3,545
Total contributions received or receivable from employer(s)	2015-12-31	$48,129
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$221
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$297,869
Expenses. Total of all expenses incurred	2014-12-31	$48
Total plan assets at end of year	2014-12-31	$1,932,223
Total plan assets at beginning of year	2014-12-31	$1,634,402
Value of fidelity bond covering the plan	2014-12-31	$200,000
Total contributions received or receivable from participants	2014-12-31	$97,024
Other income received	2014-12-31	$83,368
Net income (gross income less expenses)	2014-12-31	$297,821
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,932,223
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,634,402
Assets. Value of participant loans	2014-12-31	$5,648
Total contributions received or receivable from employer(s)	2014-12-31	$117,477
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$48
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : SOUTHERN COLORADO VETERINARY SURGERY 401K 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	$435,877
Expenses. Total of all expenses incurred	2013-12-31	$143,816
Benefits paid (including direct rollovers)	2013-12-31	$143,678
Total plan assets at end of year	2013-12-31	$1,634,402
Total plan assets at beginning of year	2013-12-31	$1,342,341
Value of fidelity bond covering the plan	2013-12-31	$200,000
Total contributions received or receivable from participants	2013-12-31	$82,152
Other income received	2013-12-31	$315,982
Net income (gross income less expenses)	2013-12-31	$292,061
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,634,402
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,342,341
Assets. Value of participant loans	2013-12-31	$8,748
Total contributions received or receivable from employer(s)	2013-12-31	$37,743
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$138
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2010 : SOUTHERN COLORADO VETERINARY SURGERY 401K 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	$260,686
Expenses. Total of all expenses incurred	2010-12-31	$5,960
Benefits paid (including direct rollovers)	2010-12-31	$5,960
Total plan assets at end of year	2010-12-31	$910,021
Total plan assets at beginning of year	2010-12-31	$655,295
Value of fidelity bond covering the plan	2010-12-31	$40,000
Total contributions received or receivable from participants	2010-12-31	$65,255
Other income received	2010-12-31	$95,317
Net income (gross income less expenses)	2010-12-31	$254,726
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$910,021
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$655,295
Assets. Value of participant loans	2010-12-31	$1,544
Total contributions received or receivable from employer(s)	2010-12-31	$100,114
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN

2016: SOUTHERN COLORADO VETERINARY SURGERY 401K 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: SOUTHERN COLORADO VETERINARY SURGERY 401K 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: SOUTHERN COLORADO VETERINARY SURGERY 401K 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: SOUTHERN COLORADO VETERINARY SURGERY 401K 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 – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2009: SOUTHERN COLORADO VETERINARY SURGERY 401K 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 – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2007: SOUTHERN COLORADO VETERINARY SURGERY 401K PROFIT SHARING PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	Yes
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan funding arrangement – Trust	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes
2007-01-01	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

46215

Policy instance

Insurance contract or identification number	46215
Number of Individuals Covered	36
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,934
Total amount of fees paid to insurance company	USD $1,174
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 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 $4,934
Insurance broker organization code?	3
Amount paid for insurance broker fees	1174
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	HUNTER BENEFITS CONSULTING GROUP

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

Policy contract number

46215

Policy instance

Insurance contract or identification number	46215
Number of Individuals Covered	31
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,048
Total amount of fees paid to insurance company	USD $872
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 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 $5,048
Insurance broker organization code?	3
Amount paid for insurance broker fees	872
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	HUNTER BENEFITS CONSULTING GROUP

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

Policy contract number

46215

Policy instance

Insurance contract or identification number	46215
Number of Individuals Covered	24
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,445
Total amount of fees paid to insurance company	USD $831
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 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 $4,445
Insurance broker organization code?	3
Amount paid for insurance broker fees	831
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	HUNTER BENEFITS CONSULTING GROUP

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

Policy contract number

46215

Policy instance

Insurance contract or identification number	46215
Number of Individuals Covered	21
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,543
Total amount of fees paid to insurance company	USD $379
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 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 $2,543
Insurance broker organization code?	3
Amount paid for insurance broker fees	379
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	HUNTER BENEFITS CONSULTING GROUP

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Company Name:	SOUTHERN COLORADO VETERINARY SURGERY
Employer identification number (EIN):	841333270
NAIC Classification:	541940
NAIC Description:	Veterinary Services