401k Plan data: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN plan

DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 401k Plan overview

Plan Name	DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN
Plan identification number	002

DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT 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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

DAHL-CHASE DIAGNOSTIC SERVICES has sponsored the creation of one or more 401k plans.

Company Name: DAHL-CHASE DIAGNOSTIC SERVICES

Employer identification number (EIN): 010391945

NAIC Classification: 621510
NAIC Description: Medical and Diagnostic Laboratories

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT 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
002 2018-01-01
002 2017-01-01
002 2016-01-01
002 2015-01-01
002 2014-01-01
002 2013-01-01
002 2012-01-01 GEOFFREY TOLZMANN GEOFFREY TOLZMANN 2013-10-08
002 2011-01-01 GEOFFREY TOLZMANN GEOFFREY TOLZMANN 2012-07-17
002 2010-01-01 GEOFFREY TOLZMANN GEOFFREY TOLZMANN 2011-07-01
002 2009-01-01 GEOFFREY TOLZMANN GEOFFREY TOLZMANN 2010-07-27
002 2009-01-01 GEOFFREY TOLZMANN GEOFFREY TOLZMANN 2010-07-27

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01
002	2021-01-01
002	2020-01-01
002	2019-01-01
002	2018-01-01
002	2017-01-01
002	2016-01-01
002	2015-01-01
002	2014-01-01
002	2013-01-01
002	2012-01-01	GEOFFREY TOLZMANN	GEOFFREY TOLZMANN	2013-10-08
002	2011-01-01	GEOFFREY TOLZMANN	GEOFFREY TOLZMANN	2012-07-17
002	2010-01-01	GEOFFREY TOLZMANN	GEOFFREY TOLZMANN	2011-07-01
002	2009-01-01	GEOFFREY TOLZMANN	GEOFFREY TOLZMANN	2010-07-27
002	2009-01-01	GEOFFREY TOLZMANN	GEOFFREY TOLZMANN	2010-07-27

Plan Statistics for DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN

401k plan membership statisitcs for DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN

Measure Date Value
2016: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 101
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 74
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 20
Total of all active and inactive participants 2016-01-01 94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 94
Number of participants with account balances 2016-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 72
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 28
Total of all active and inactive participants 2015-01-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 100
Number of participants with account balances 2015-01-01 100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 137
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 77
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 55
Total of all active and inactive participants 2014-01-01 132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 132
Number of participants with account balances 2014-01-01 132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 2
2013: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 112
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 21
Total of all active and inactive participants 2013-01-01 133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 133
Number of participants with account balances 2013-01-01 133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2012: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 114
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 14
Total of all active and inactive participants 2012-01-01 128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 129
Number of participants with account balances 2012-01-01 115
2011: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 129
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 115
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 14
Total of all active and inactive participants 2011-01-01 129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 129
Number of participants with account balances 2011-01-01 116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 130
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 116
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 9
Total of all active and inactive participants 2010-01-01 125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 1
Total participants 2010-01-01 126
Number of participants with account balances 2010-01-01 112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 123
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 112
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 7
Total of all active and inactive participants 2009-01-01 119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 119
Number of participants with account balances 2009-01-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2016: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	101
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	74
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	20
Total of all active and inactive participants	2016-01-01	94
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	94
Number of participants with account balances	2016-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	72
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	28
Total of all active and inactive participants	2015-01-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	100
Number of participants with account balances	2015-01-01	100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	137
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	77
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	55
Total of all active and inactive participants	2014-01-01	132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	132
Number of participants with account balances	2014-01-01	132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	2
2013: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	112
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	21
Total of all active and inactive participants	2013-01-01	133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	133
Number of participants with account balances	2013-01-01	133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2012: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	114
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	14
Total of all active and inactive participants	2012-01-01	128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	129
Number of participants with account balances	2012-01-01	115
2011: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	129
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	115
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	14
Total of all active and inactive participants	2011-01-01	129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	129
Number of participants with account balances	2011-01-01	116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	130
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	116
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	9
Total of all active and inactive participants	2010-01-01	125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	1
Total participants	2010-01-01	126
Number of participants with account balances	2010-01-01	112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	123
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	112
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	7
Total of all active and inactive participants	2009-01-01	119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	119
Number of participants with account balances	2009-01-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN

Measure	Date	Value
2016 : DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2016 401k financial data
Total income from all sources (including contributions)	2016-12-31	$1,862,488
Total of all expenses incurred	2016-12-31	$1,510,156
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$1,507,731
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,117,094
Value of total assets at end of year	2016-12-31	$13,684,657
Value of total assets at beginning of year	2016-12-31	$13,332,325
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$2,425
Total interest from all sources	2016-12-31	$11,077
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$553,732
Participant contributions at end of year	2016-12-31	$247,319
Participant contributions at beginning of year	2016-12-31	$254,170
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$8,864
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$352,332
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$13,684,657
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$13,332,325
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$12,517,894
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$12,233,301
Interest on participant loans	2016-12-31	$11,077
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$640,851
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$574,921
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$734,317
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$554,498
Employer contributions (assets) at end of year	2016-12-31	$278,593
Employer contributions (assets) at beginning of year	2016-12-31	$269,933
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$1,507,731
Contract administrator fees	2016-12-31	$2,425
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	BERRY, DUNN, MCNEIL & PARKER
Accountancy firm EIN	2016-12-31	010523282
2015 : DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$1,151,269
Total of all expenses incurred	2015-12-31	$352,235
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$350,055
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,201,542
Value of total assets at end of year	2015-12-31	$13,332,325
Value of total assets at beginning of year	2015-12-31	$12,533,291
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$2,180
Total interest from all sources	2015-12-31	$10,767
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$572,949
Participant contributions at end of year	2015-12-31	$254,170
Participant contributions at beginning of year	2015-12-31	$237,647
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$82,035
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$799,034
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$13,332,325
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$12,533,291
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$12,233,301
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$11,537,433
Interest on participant loans	2015-12-31	$10,788
Interest earned on other investments	2015-12-31	$-21
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$574,921
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$497,357
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-61,040
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$546,558
Employer contributions (assets) at end of year	2015-12-31	$269,933
Employer contributions (assets) at beginning of year	2015-12-31	$260,854
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$350,055
Contract administrator fees	2015-12-31	$2,180
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	BERRY, DUNN, MCNEIL & PARKER
Accountancy firm EIN	2015-12-31	010523282
2014 : DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2014 401k financial data
Total income from all sources (including contributions)	2014-12-31	$1,770,306
Total of all expenses incurred	2014-12-31	$855,943
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$853,410
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,184,305
Value of total assets at end of year	2014-12-31	$12,533,291
Value of total assets at beginning of year	2014-12-31	$11,618,928
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$2,533
Total interest from all sources	2014-12-31	$12,297
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$609,044
Participant contributions at end of year	2014-12-31	$237,647
Participant contributions at beginning of year	2014-12-31	$290,597
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$14,947
Administrative expenses (other) incurred	2014-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$914,363
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$12,533,291
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$11,618,928
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$11,537,433
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$10,413,930
Interest on participant loans	2014-12-31	$11,328
Interest earned on other investments	2014-12-31	$969
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$497,357
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$689,432
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$573,704
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$560,314
Employer contributions (assets) at end of year	2014-12-31	$260,854
Employer contributions (assets) at beginning of year	2014-12-31	$224,969
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$853,410
Contract administrator fees	2014-12-31	$2,533
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	BERRY, DUNN, MCNEIL & PARKER
Accountancy firm EIN	2014-12-31	010523282
2013 : DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2013 401k financial data
Total income from all sources (including contributions)	2013-12-31	$2,721,212
Total of all expenses incurred	2013-12-31	$161,100
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$159,385
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,207,416
Value of total assets at end of year	2013-12-31	$11,618,928
Value of total assets at beginning of year	2013-12-31	$9,058,816
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$1,715
Total interest from all sources	2013-12-31	$9,747
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$668,006
Participant contributions at end of year	2013-12-31	$290,597
Participant contributions at beginning of year	2013-12-31	$200,615
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$2,560,112
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$11,618,928
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$9,058,816
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$10,413,930
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$7,996,058
Interest on participant loans	2013-12-31	$9,817
Interest earned on other investments	2013-12-31	$-70
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$689,432
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$862,143
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$1,504,049
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$539,410
Employer contributions (assets) at end of year	2013-12-31	$224,969
Employer contributions (assets) at beginning of year	2013-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$159,385
Contract administrator fees	2013-12-31	$1,715
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	BERRY, DUNN, MCNEIL & PARKER
Accountancy firm EIN	2013-12-31	010523282
2012 : DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2012 401k financial data
Total income from all sources (including contributions)	2012-12-31	$2,122,688
Total of all expenses incurred	2012-12-31	$838,852
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$811,094
Expenses. Certain deemed distributions of participant loans	2012-12-31	$26,783
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$1,012,991
Value of total assets at end of year	2012-12-31	$9,058,816
Value of total assets at beginning of year	2012-12-31	$7,774,980
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$975
Total interest from all sources	2012-12-31	$7,344
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$645,650
Participant contributions at end of year	2012-12-31	$200,615
Participant contributions at beginning of year	2012-12-31	$174,962
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$723
Other income not declared elsewhere	2012-12-31	$3,963
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$1,283,836
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$9,058,816
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$7,774,980
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$7,996,058
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$6,947,204
Interest on participant loans	2012-12-31	$7,344
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$862,143
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$652,814
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$1,098,390
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$366,618
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$811,094
Contract administrator fees	2012-12-31	$975
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	RON L. BEAULIEU & COMPANY
Accountancy firm EIN	2012-12-31	010442893
2011 : DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2011 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$782,997
Total of all expenses incurred	2011-12-31	$316,353
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$315,878
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$1,076,937
Value of total assets at end of year	2011-12-31	$7,774,980
Value of total assets at beginning of year	2011-12-31	$7,308,336
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$475
Total interest from all sources	2011-12-31	$8,425
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$646,283
Participant contributions at end of year	2011-12-31	$174,962
Participant contributions at beginning of year	2011-12-31	$189,751
Participant contributions at end of year	2011-12-31	$0
Participant contributions at beginning of year	2011-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$5,848
Other income not declared elsewhere	2011-12-31	$1,269
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$466,644
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$7,774,980
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$7,308,336
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$6,947,204
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$6,426,179
Interest on participant loans	2011-12-31	$8,425
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$652,814
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$692,406
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-303,634
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$424,806
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$315,878
Contract administrator fees	2011-12-31	$475
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	WILLIAMS & ASSOCIATES, P.A.
Accountancy firm EIN	2011-12-31	043374690
2010 : DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$1,653,769
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$357,382
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$355,867
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$1,014,481
Value of total assets at end of year	2010-12-31	$7,308,336
Value of total assets at beginning of year	2010-12-31	$6,011,949
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,515
Total interest from all sources	2010-12-31	$8,362
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$613,809
Participant contributions at end of year	2010-12-31	$189,751
Participant contributions at beginning of year	2010-12-31	$149,378
Participant contributions at end of year	2010-12-31	$0
Participant contributions at beginning of year	2010-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$3,393
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$0
Other income not declared elsewhere	2010-12-31	$1,547
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$1,296,387
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$7,308,336
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$6,011,949
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$6,426,179
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$5,862,571
Interest on participant loans	2010-12-31	$8,362
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$692,406
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$629,379
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$397,279
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$355,867
Contract administrator fees	2010-12-31	$1,515
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	Yes
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	BERRY, DUNN, MCNEIL & PARKER
Accountancy firm EIN	2010-12-31	010523282

Form 5500 Responses for DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN

2016: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT 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 - Trust	Yes
2015: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT 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 - Trust	Yes
2014: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT 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 - Trust	Yes
2013: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT 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 - Trust	Yes
2012: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT 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 – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT 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 – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: DAHL-CHASE DIAGNOSTIC SERVICES RETIREMENT 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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331651-01

Policy instance

Insurance contract or identification number	331651-01
Number of Individuals Covered	100
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,360
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $1,360
Insurance broker organization code?	3
Insurance broker name	PETER COOPERSMITH

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331651-01

Policy instance

Insurance contract or identification number	331651-01
Number of Individuals Covered	132
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,223
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $1,223
Insurance broker organization code?	3
Insurance broker name	PETER COOPERSMITH

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331651-01

Policy instance

Insurance contract or identification number	331651-01
Number of Individuals Covered	133
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,522
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $1,522
Insurance broker organization code?	3
Insurance broker name	PETER COOPERSMITH

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331651-01

Policy instance

Insurance contract or identification number	331651-01
Number of Individuals Covered	115
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,995
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $1,995
Insurance broker organization code?	3
Insurance broker name	PETER COOPERSMITH

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331651-01

Policy instance

Insurance contract or identification number	331651-01
Number of Individuals Covered	116
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $1,611
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331651-01

Policy instance

Insurance contract or identification number	331651-01
Number of Individuals Covered	112
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $887
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Other information about contract	GROUP ANNUITY CONTRACT
Commission paid to Insurance Broker	USD $887
Insurance broker organization code?	3
Insurance broker name	PETER COOPERSMITH

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Company Name:	DAHL-CHASE DIAGNOSTIC SERVICES
Employer identification number (EIN):	010391945
NAIC Classification:	621510
NAIC Description:	Medical and Diagnostic Laboratories