401k Plan data: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN plan

HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN
Plan identification number	004

HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
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.
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

HAMPTON EYE PHYSICIANS & SURGEONS, P.C. has sponsored the creation of one or more 401k plans.

Company Name: HAMPTON EYE PHYSICIANS & SURGEONS, P.C.

Employer identification number (EIN): 112372821

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

Additional information about HAMPTON EYE PHYSICIANS & SURGEONS, P.C.

Jurisdiction of Incorporation: New York Department of State

Incorporation Date: 1975-01-27

Company Identification Number: 361158

Legal Registered Office Address: PAUL A CHOINSKI
186 OLD TOWN RD.
SOUTHAMPTON
United States of America (USA)
11968

More information about HAMPTON EYE PHYSICIANS & SURGEONS, P.C.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
004 2015-01-01 PAUL A. CHOINSKI 2016-07-21 PAUL A. CHOINSKI 2016-07-21
004 2014-01-01 PAUL CHOINSKI 2015-06-09 PAUL CHOINSKI 2015-06-09
004 2013-01-01 PAUL CHOINSKI PAUL CHOINSKI 2014-04-08
004 2012-01-01 PAUL CHOINSKI
004 2011-01-01 PAUL CHOINSKI
004 2010-01-01 PAUL CHOINSKI
004 2009-01-01 PAUL CHOINSKI

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
004	2015-01-01	PAUL A. CHOINSKI	2016-07-21	PAUL A. CHOINSKI	2016-07-21
004	2014-01-01	PAUL CHOINSKI	2015-06-09	PAUL CHOINSKI	2015-06-09
004	2013-01-01	PAUL CHOINSKI		PAUL CHOINSKI	2014-04-08
004	2012-01-01	PAUL CHOINSKI
004	2011-01-01	PAUL CHOINSKI
004	2010-01-01	PAUL CHOINSKI
004	2009-01-01	PAUL CHOINSKI

Plan Statistics for HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN

Measure Date Value
2013: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 16
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 16
Number of participants with account balances 2013-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 11
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 11
Number of participants with account balances 2012-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 11
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 11
Number of participants with account balances 2011-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 10
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 0
Total of all active and inactive participants 2010-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 10
Number of participants with account balances 2010-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 10
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 0
Total of all active and inactive participants 2009-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 10
Number of participants with account balances 2009-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2013: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	16
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	16
Number of participants with account balances	2013-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	11
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	11
Number of participants with account balances	2012-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	11
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	11
Number of participants with account balances	2011-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	10
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	0
Total of all active and inactive participants	2010-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	10
Number of participants with account balances	2010-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	10
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	0
Total of all active and inactive participants	2009-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	10
Number of participants with account balances	2009-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2013 : HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
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	$386,588
Expenses. Total of all expenses incurred	2013-12-31	$278,458
Benefits paid (including direct rollovers)	2013-12-31	$256,139
Total plan assets at end of year	2013-12-31	$2,028,715
Total plan assets at beginning of year	2013-12-31	$1,920,585
Value of fidelity bond covering the plan	2013-12-31	$120,000
Total contributions received or receivable from participants	2013-12-31	$39,026
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$323,672
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$108,130
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,028,715
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,920,585
Assets. Value of participant loans	2013-12-31	$3,667
Total contributions received or receivable from employer(s)	2013-12-31	$23,890
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$22,319
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$281,795
Expenses. Total of all expenses incurred	2012-12-31	$21,980
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$1,920,585
Total plan assets at beginning of year	2012-12-31	$1,660,770
Value of fidelity bond covering the plan	2012-12-31	$120,000
Total contributions received or receivable from participants	2012-12-31	$43,855
Expenses. Other expenses not covered elsewhere	2012-12-31	$916
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$216,163
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$259,815
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,920,585
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,660,770
Assets. Value of participant loans	2012-12-31	$12,592
Total contributions received or receivable from employer(s)	2012-12-31	$21,777
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$21,064
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$86,294
Expenses. Total of all expenses incurred	2011-12-31	$20,770
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$1,660,770
Total plan assets at beginning of year	2011-12-31	$1,595,246
Value of fidelity bond covering the plan	2011-12-31	$120,000
Total contributions received or receivable from participants	2011-12-31	$39,894
Expenses. Other expenses not covered elsewhere	2011-12-31	$916
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-17,600
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$65,524
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,660,770
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,595,246
Assets. Value of participant loans	2011-12-31	$22,982
Total contributions received or receivable from employer(s)	2011-12-31	$64,000
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$19,854
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
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	$302,262
Expenses. Total of all expenses incurred	2010-12-31	$21,469
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$1,595,246
Total plan assets at beginning of year	2010-12-31	$1,314,453
Value of fidelity bond covering the plan	2010-12-31	$120,000
Total contributions received or receivable from participants	2010-12-31	$43,226
Expenses. Other expenses not covered elsewhere	2010-12-31	$916
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$195,036
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$280,793
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,595,246
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,314,453
Assets. Value of participant loans	2010-12-31	$31,559
Total contributions received or receivable from employer(s)	2010-12-31	$64,000
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$20,553
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) 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 HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN

2013: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING 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 – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: HAMPTON EYE PHYSICIANS & SURGEONS, P.C. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – 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

Insurance Providers Used on plan

COMMONWEALTH ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 84824 )

Policy contract number

L448412L844414

Policy instance

Insurance contract or identification number	L448412L844414
Number of Individuals Covered	2
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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

COMMONWEALTH ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 84824 )

Policy contract number

L448412L844414

Policy instance

Insurance contract or identification number	L448412L844414
Number of Individuals Covered	2
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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

COMMONWEALTH ANNUITY AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 84824 )

Policy contract number

L448412L448414

Policy instance

Insurance contract or identification number	L448412L448414
Number of Individuals Covered	2
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
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

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Company Name:	HAMPTON EYE PHYSICIANS & SURGEONS, P.C.
Employer identification number (EIN):	112372821
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	New York Department of State
Incorporation Date:	1975-01-27
Company Identification Number:	361158
Legal Registered Office Address:	PAUL A CHOINSKI 186 OLD TOWN RD. SOUTHAMPTON United States of America (USA) 11968