401k Plan data: JEFFREY C LONG MD 401K PROFIT SHARING PLAN plan

JEFFREY C LONG MD 401K PROFIT SHARING PLAN 401k Plan overview

Plan Name	JEFFREY C LONG MD 401K PROFIT SHARING PLAN
Plan identification number	001

JEFFREY C LONG MD 401K PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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.
Plan covering Self-Employed individuals.
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

JEFFREY C LONG MD has sponsored the creation of one or more 401k plans.

Company Name: JEFFREY C LONG MD

Employer identification number (EIN): 161311940

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JEFFREY C LONG MD 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 JEFFREY C. LONG MD 2022-10-19
001 2020-01-01 JEFFREY LONG 2021-10-24
001 2019-01-01 JEFFREY C. LONG MD 2020-10-22
001 2018-01-01 JEFFREY LONG 2019-10-14
001 2018-01-01 JEFFREY LONG 2019-10-14
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01
001 2013-01-01
001 2012-01-01 SANDRA RAPSON
001 2011-01-01 SANDRA RAPSON
001 2009-01-01 SANDRA RAPSON

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-01-01	JEFFREY C. LONG MD	2022-10-19
001	2020-01-01	JEFFREY LONG	2021-10-24
001	2019-01-01	JEFFREY C. LONG MD	2020-10-22
001	2018-01-01			JEFFREY LONG	2019-10-14
001	2018-01-01	JEFFREY LONG	2019-10-14
001	2017-01-01
001	2016-01-01
001	2015-01-01
001	2014-01-01
001	2013-01-01
001	2012-01-01	SANDRA RAPSON
001	2011-01-01	SANDRA RAPSON
001	2009-01-01	SANDRA RAPSON

Plan Statistics for JEFFREY C LONG MD 401K PROFIT SHARING PLAN

401k plan membership statisitcs for JEFFREY C LONG MD 401K PROFIT SHARING PLAN

Measure Date Value
2021: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 8
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 6
Total of all active and inactive participants 2021-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 14
Number of participants with account balances 2021-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 19
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 11
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 6
Total of all active and inactive participants 2020-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 17
Number of participants with account balances 2020-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 13
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 5
Total of all active and inactive participants 2019-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 18
Number of participants with account balances 2019-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 14
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 4
Total of all active and inactive participants 2018-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 18
Number of participants with account balances 2018-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 12
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 4
Total of all active and inactive participants 2017-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 16
Number of participants with account balances 2017-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 13
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 5
Total of all active and inactive participants 2016-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 18
Number of participants with account balances 2016-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 13
Number of retired or separated participants receiving benefits 2015-01-01 5
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 18
Number of participants with account balances 2015-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 14
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 3
Total of all active and inactive participants 2014-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 17
Number of participants with account balances 2014-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 15
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 3
Total of all active and inactive participants 2013-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 18
Number of participants with account balances 2013-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 13
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 3
Total of all active and inactive participants 2012-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 16
Number of participants with account balances 2012-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 14
Number of retired or separated participants receiving benefits 2011-01-01 3
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 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 17
Number of participants with account balances 2011-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 17
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 2
Total of all active and inactive participants 2009-01-01 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 19
Number of participants with account balances 2009-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2021: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	8
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	6
Total of all active and inactive participants	2021-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	14
Number of participants with account balances	2021-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	19
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	11
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	6
Total of all active and inactive participants	2020-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	17
Number of participants with account balances	2020-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	13
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	5
Total of all active and inactive participants	2019-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	18
Number of participants with account balances	2019-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	14
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	4
Total of all active and inactive participants	2018-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	18
Number of participants with account balances	2018-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	12
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	4
Total of all active and inactive participants	2017-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	16
Number of participants with account balances	2017-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	13
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	5
Total of all active and inactive participants	2016-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	18
Number of participants with account balances	2016-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	13
Number of retired or separated participants receiving benefits	2015-01-01	5
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	18
Number of participants with account balances	2015-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	14
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	3
Total of all active and inactive participants	2014-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	17
Number of participants with account balances	2014-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	15
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	3
Total of all active and inactive participants	2013-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	18
Number of participants with account balances	2013-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	13
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	3
Total of all active and inactive participants	2012-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	16
Number of participants with account balances	2012-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	14
Number of retired or separated participants receiving benefits	2011-01-01	3
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	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	17
Number of participants with account balances	2011-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	17
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	2
Total of all active and inactive participants	2009-01-01	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	19
Number of participants with account balances	2009-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on JEFFREY C LONG MD 401K PROFIT SHARING PLAN

Measure	Date	Value
2021 : JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2021 401k financial data
Transfers to/from the plan	2021-12-31	$0
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$213,928
Expenses. Total of all expenses incurred	2021-12-31	$734,290
Benefits paid (including direct rollovers)	2021-12-31	$734,190
Total plan assets at end of year	2021-12-31	$1,122,553
Total plan assets at beginning of year	2021-12-31	$1,642,915
Value of fidelity bond covering the plan	2021-12-31	$200,000
Total contributions received or receivable from participants	2021-12-31	$24,145
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$178,989
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$-520,362
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$1,122,553
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$1,642,915
Total contributions received or receivable from employer(s)	2021-12-31	$10,794
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$100
2020 : JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2020 401k financial data
Transfers to/from the plan	2020-12-31	$0
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$236,461
Expenses. Total of all expenses incurred	2020-12-31	$9,169
Benefits paid (including direct rollovers)	2020-12-31	$8,981
Total plan assets at end of year	2020-12-31	$1,642,915
Total plan assets at beginning of year	2020-12-31	$1,415,623
Value of fidelity bond covering the plan	2020-12-31	$20,000
Total contributions received or receivable from participants	2020-12-31	$35,238
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$184,337
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$227,292
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$1,642,915
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$1,415,623
Assets. Value of participant loans	2020-12-31	$14,912
Total contributions received or receivable from employer(s)	2020-12-31	$16,886
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$188
2019 : JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$267,582
Expenses. Total of all expenses incurred	2019-12-31	$187
Benefits paid (including direct rollovers)	2019-12-31	$0
Total plan assets at end of year	2019-12-31	$1,415,623
Total plan assets at beginning of year	2019-12-31	$1,148,228
Value of fidelity bond covering the plan	2019-12-31	$20,000
Total contributions received or receivable from participants	2019-12-31	$32,556
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$218,364
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$267,395
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$1,415,623
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$1,148,228
Assets. Value of participant loans	2019-12-31	$29,572
Total contributions received or receivable from employer(s)	2019-12-31	$16,662
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$187
2018 : JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2018 401k financial data
Transfers to/from the plan	2018-12-31	$0
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$0
Total income from all sources	2018-12-31	$-24,585
Expenses. Total of all expenses incurred	2018-12-31	$150
Benefits paid (including direct rollovers)	2018-12-31	$0
Total plan assets at end of year	2018-12-31	$1,148,228
Total plan assets at beginning of year	2018-12-31	$1,172,963
Value of fidelity bond covering the plan	2018-12-31	$20,000
Total contributions received or receivable from participants	2018-12-31	$33,158
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$-76,247
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$-24,735
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$1,148,228
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$1,172,963
Assets. Value of participant loans	2018-12-31	$29,572
Total contributions received or receivable from employer(s)	2018-12-31	$18,504
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$150
2017 : JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2017 401k financial data
Transfers to/from the plan	2017-12-31	$0
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$204,418
Expenses. Total of all expenses incurred	2017-12-31	$79,209
Benefits paid (including direct rollovers)	2017-12-31	$79,096
Total plan assets at end of year	2017-12-31	$1,172,963
Total plan assets at beginning of year	2017-12-31	$1,047,754
Value of fidelity bond covering the plan	2017-12-31	$20,000
Total contributions received or receivable from participants	2017-12-31	$38,303
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$0
Other income received	2017-12-31	$143,294
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$125,209
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$1,172,963
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$1,047,754
Assets. Value of participant loans	2017-12-31	$31,570
Total contributions received or receivable from employer(s)	2017-12-31	$22,821
Value of certain deemed distributions of participant loans	2017-12-31	$0
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$113
2016 : JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$134,093
Expenses. Total of all expenses incurred	2016-12-31	$92,622
Benefits paid (including direct rollovers)	2016-12-31	$92,559
Total plan assets at end of year	2016-12-31	$1,047,754
Total plan assets at beginning of year	2016-12-31	$1,006,283
Value of fidelity bond covering the plan	2016-12-31	$20,000
Total contributions received or receivable from participants	2016-12-31	$37,543
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$0
Other income received	2016-12-31	$77,317
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$41,471
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,047,754
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,006,283
Assets. Value of participant loans	2016-12-31	$16,838
Total contributions received or receivable from employer(s)	2016-12-31	$19,233
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$63
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$67,223
Expenses. Total of all expenses incurred	2015-12-31	$50
Benefits paid (including direct rollovers)	2015-12-31	$0
Total plan assets at end of year	2015-12-31	$1,006,283
Total plan assets at beginning of year	2015-12-31	$939,110
Value of fidelity bond covering the plan	2015-12-31	$20,000
Assets. Value of tangible personal property	2015-12-31	$0
Total contributions received or receivable from participants	2015-12-31	$52,411
Assets. Value of loans (other than to participants)	2015-12-31	$0
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-12,571
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$67,173
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,006,283
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$939,110
Assets. Value of participant loans	2015-12-31	$5,959
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2015-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2015-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$0
Assets. Value of real-estate (other than employer real property)	2015-12-31	$0
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	$0
Assets. Value of employer securities	2015-12-31	$0
Assets. Value of employer real property	2015-12-31	$0
Total contributions received or receivable from employer(s)	2015-12-31	$27,383
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$50
2014 : JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
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	$121,135
Expenses. Total of all expenses incurred	2014-12-31	$13
Benefits paid (including direct rollovers)	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$939,110
Total plan assets at beginning of year	2014-12-31	$817,988
Value of fidelity bond covering the plan	2014-12-31	$20,000
Assets. Value of tangible personal property	2014-12-31	$0
Total contributions received or receivable from participants	2014-12-31	$50,120
Assets. Value of loans (other than to participants)	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$44,267
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$121,122
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$939,110
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$817,988
Assets. Value of participant loans	2014-12-31	$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2014-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2014-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2014-12-31	$0
Assets. Value of real-estate (other than employer real property)	2014-12-31	$0
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	2014-12-31	$0
Assets. Value of employer securities	2014-12-31	$0
Assets. Value of employer real property	2014-12-31	$0
Total contributions received or receivable from employer(s)	2014-12-31	$26,748
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$13
2013 : JEFFREY C LONG MD 401K 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	$154,104
Expenses. Total of all expenses incurred	2013-12-31	$0
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$817,988
Total plan assets at beginning of year	2013-12-31	$663,884
Value of fidelity bond covering the plan	2013-12-31	$20,000
Assets. Value of tangible personal property	2013-12-31	$0
Total contributions received or receivable from participants	2013-12-31	$25,497
Assets. Value of loans (other than to participants)	2013-12-31	$0
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	$82,531
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$154,104
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$817,988
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$663,884
Assets. Value of participant loans	2013-12-31	$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2013-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2013-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2013-12-31	$0
Assets. Value of real-estate (other than employer real property)	2013-12-31	$0
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	2013-12-31	$0
Assets. Value of employer securities	2013-12-31	$0
Assets. Value of employer real property	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$46,076
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	$0
2012 : JEFFREY C LONG MD 401K 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	$127,797
Expenses. Total of all expenses incurred	2012-12-31	$0
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$663,884
Total plan assets at beginning of year	2012-12-31	$536,087
Value of fidelity bond covering the plan	2012-12-31	$20,000
Assets. Value of tangible personal property	2012-12-31	$0
Total contributions received or receivable from participants	2012-12-31	$25,231
Assets. Value of loans (other than to participants)	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$57,166
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$127,797
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$663,884
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$536,087
Assets. Value of participant loans	2012-12-31	$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2012-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2012-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2012-12-31	$0
Assets. Value of real-estate (other than employer real property)	2012-12-31	$0
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	2012-12-31	$0
Assets. Value of employer securities	2012-12-31	$0
Assets. Value of employer real property	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$45,400
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	$0
2011 : JEFFREY C LONG MD 401K 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	$59,673
Expenses. Total of all expenses incurred	2011-12-31	$0
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$536,087
Total plan assets at beginning of year	2011-12-31	$476,414
Value of fidelity bond covering the plan	2011-12-31	$20,000
Assets. Value of tangible personal property	2011-12-31	$0
Total contributions received or receivable from participants	2011-12-31	$40,952
Assets. Value of loans (other than to participants)	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$5,071
Other income received	2011-12-31	$-10,553
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$59,673
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$536,087
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$476,414
Assets. Value of participant loans	2011-12-31	$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2011-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2011-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$0
Assets. Value of real-estate (other than employer real property)	2011-12-31	$0
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	2011-12-31	$0
Assets. Value of employer securities	2011-12-31	$0
Assets. Value of employer real property	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$24,203
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	$0
2010 : JEFFREY C LONG MD 401K 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	$98,818
Expenses. Total of all expenses incurred	2010-12-31	$0
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$476,414
Total plan assets at beginning of year	2010-12-31	$377,596
Value of fidelity bond covering the plan	2010-12-31	$20,000
Assets. Value of tangible personal property	2010-12-31	$0
Total contributions received or receivable from participants	2010-12-31	$26,865
Assets. Value of loans (other than to participants)	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$59,829
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$98,818
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$476,414
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$377,596
Assets. Value of participant loans	2010-12-31	$0
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year	2010-12-31	$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year	2010-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$0
Assets. Value of real-estate (other than employer real property)	2010-12-31	$0
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	2010-12-31	$0
Assets. Value of employer securities	2010-12-31	$0
Assets. Value of employer real property	2010-12-31	$0
Total contributions received or receivable from employer(s)	2010-12-31	$12,124
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	$0
2009 : JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2009 401k financial data
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers	2009-12-31	0
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 JEFFREY C LONG MD 401K PROFIT SHARING PLAN

2021: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: JEFFREY C LONG MD 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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: JEFFREY C LONG MD 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: JEFFREY C LONG MD 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: JEFFREY C LONG MD 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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: JEFFREY C LONG MD 401K PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: JEFFREY C LONG MD 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 – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380394-01

Policy instance

Insurance contract or identification number	380394-01
Number of Individuals Covered	11
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $5,108
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,108
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380394-01

Policy instance

Insurance contract or identification number	380394-01
Number of Individuals Covered	14
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $4,841
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,841
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380394-01

Policy instance

Insurance contract or identification number	380394-01
Number of Individuals Covered	14
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,398
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,398
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380394-01

Policy instance

Insurance contract or identification number	380394-01
Number of Individuals Covered	14
Total amount of commissions paid to insurance broker	USD $4,081
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,081
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380394-01

Policy instance

Insurance contract or identification number	380394-01
Number of Individuals Covered	14
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,814
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,974
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	MARK MODZELESKI

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380394-01

Policy instance

Insurance contract or identification number	380394-01
Number of Individuals Covered	16
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,361
Total amount of fees paid to insurance company	USD $0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,361
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES YOUNG

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380394-01

Policy instance

Insurance contract or identification number	380394-01
Number of Individuals Covered	16
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $2,986
Total amount of fees paid to insurance company	USD $0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,986
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES YOUNG

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380394-01

Policy instance

Insurance contract or identification number	380394-01
Number of Individuals Covered	15
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,497
Total amount of fees paid to insurance company	USD $0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,497
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES YOUNG

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )

Policy contract number

380394-01

Policy instance

Insurance contract or identification number	380394-01
Number of Individuals Covered	14
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,215
Total amount of fees paid to insurance company	USD $0
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,215
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES YOUNG

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Company Name:	JEFFREY C LONG MD
Employer identification number (EIN):	161311940
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)