401k Plan data: KEYSTONE EYE ASSOCIATES, LLC PLAN plan

KEYSTONE EYE ASSOCIATES, LLC PLAN 401k Plan overview

Plan Name	KEYSTONE EYE ASSOCIATES, LLC PLAN
Plan identification number	001

KEYSTONE EYE ASSOCIATES, LLC 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

KEYSTONE EYE ASSOCIATES, LLC has sponsored the creation of one or more 401k plans.

Company Name: KEYSTONE EYE ASSOCIATES, LLC

Employer identification number (EIN): 200864522

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

Additional information about KEYSTONE EYE ASSOCIATES, LLC

Jurisdiction of Incorporation: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE

Incorporation Date:

Company Identification Number: 3196440

More information about KEYSTONE EYE ASSOCIATES, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KEYSTONE EYE ASSOCIATES, LLC PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 LISA KRESZ
001 2017-01-01 LISA KRESZ
001 2016-01-01 LISA KRESZ
001 2015-01-01 LISA KRESZ
001 2014-01-01 LISA KRESZ
001 2013-01-01 LISA KRESZ
001 2012-01-01 SYLVIA SILVERMAN
001 2011-01-01 SYLVIA SILVERMAN

Plan Statistics for KEYSTONE EYE ASSOCIATES, LLC PLAN

401k plan membership statisitcs for KEYSTONE EYE ASSOCIATES, LLC PLAN

Measure Date Value
2022: KEYSTONE EYE ASSOCIATES, LLC PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 0
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 0
Number of participants with account balances 2022-01-01 0
2021: KEYSTONE EYE ASSOCIATES, LLC PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 19
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 25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 26
Number of participants with account balances 2021-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: KEYSTONE EYE ASSOCIATES, LLC PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 34
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 24
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 7
Total of all active and inactive participants 2020-01-01 31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 1
Total participants 2020-01-01 32
Number of participants with account balances 2020-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: KEYSTONE EYE ASSOCIATES, LLC PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 33
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 28
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 33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 1
Total participants 2019-01-01 34
Number of participants with account balances 2019-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: KEYSTONE EYE ASSOCIATES, LLC PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 24
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 8
Total of all active and inactive participants 2018-01-01 32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 1
Total participants 2018-01-01 33
Number of participants with account balances 2018-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: KEYSTONE EYE ASSOCIATES, LLC PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 25
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 11
Total of all active and inactive participants 2017-01-01 36
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 1
Total participants 2017-01-01 37
Number of participants with account balances 2017-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: KEYSTONE EYE ASSOCIATES, LLC PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 50
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 22
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 27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 1
Total participants 2016-01-01 28
Number of participants with account balances 2016-01-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: KEYSTONE EYE ASSOCIATES, LLC PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 58
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 20
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 29
Total of all active and inactive participants 2015-01-01 49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 1
Total participants 2015-01-01 50
Number of participants with account balances 2015-01-01 47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: KEYSTONE EYE ASSOCIATES, LLC PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 57
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 16
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 40
Total of all active and inactive participants 2014-01-01 57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 1
Total participants 2014-01-01 58
Number of participants with account balances 2014-01-01 58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: KEYSTONE EYE ASSOCIATES, LLC PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 48
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 17
Number of retired or separated participants receiving benefits 2013-01-01 1
Number of other retired or separated participants entitled to future benefits 2013-01-01 37
Total of all active and inactive participants 2013-01-01 55
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 56
Number of participants with account balances 2013-01-01 53
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: KEYSTONE EYE ASSOCIATES, LLC PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 62
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 27
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 37
Total of all active and inactive participants 2012-01-01 65
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 66
Number of participants with account balances 2012-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: KEYSTONE EYE ASSOCIATES, LLC PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 67
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 36
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 29
Total of all active and inactive participants 2011-01-01 65
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 65
Number of participants with account balances 2011-01-01 65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2022: KEYSTONE EYE ASSOCIATES, LLC PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	0
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	0
Number of participants with account balances	2022-01-01	0
2021: KEYSTONE EYE ASSOCIATES, LLC PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	19
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	25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	26
Number of participants with account balances	2021-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: KEYSTONE EYE ASSOCIATES, LLC PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	34
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	24
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	7
Total of all active and inactive participants	2020-01-01	31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	1
Total participants	2020-01-01	32
Number of participants with account balances	2020-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: KEYSTONE EYE ASSOCIATES, LLC PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	33
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	28
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	33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	1
Total participants	2019-01-01	34
Number of participants with account balances	2019-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: KEYSTONE EYE ASSOCIATES, LLC PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	24
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	8
Total of all active and inactive participants	2018-01-01	32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	1
Total participants	2018-01-01	33
Number of participants with account balances	2018-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: KEYSTONE EYE ASSOCIATES, LLC PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	25
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	11
Total of all active and inactive participants	2017-01-01	36
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	1
Total participants	2017-01-01	37
Number of participants with account balances	2017-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: KEYSTONE EYE ASSOCIATES, LLC PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	50
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	22
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	27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	1
Total participants	2016-01-01	28
Number of participants with account balances	2016-01-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: KEYSTONE EYE ASSOCIATES, LLC PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	58
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	20
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	29
Total of all active and inactive participants	2015-01-01	49
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	1
Total participants	2015-01-01	50
Number of participants with account balances	2015-01-01	47
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: KEYSTONE EYE ASSOCIATES, LLC PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	57
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	16
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	40
Total of all active and inactive participants	2014-01-01	57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	1
Total participants	2014-01-01	58
Number of participants with account balances	2014-01-01	58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: KEYSTONE EYE ASSOCIATES, LLC PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	48
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	17
Number of retired or separated participants receiving benefits	2013-01-01	1
Number of other retired or separated participants entitled to future benefits	2013-01-01	37
Total of all active and inactive participants	2013-01-01	55
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	56
Number of participants with account balances	2013-01-01	53
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: KEYSTONE EYE ASSOCIATES, LLC PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	62
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	27
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	37
Total of all active and inactive participants	2012-01-01	65
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	66
Number of participants with account balances	2012-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: KEYSTONE EYE ASSOCIATES, LLC PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	67
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	36
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	29
Total of all active and inactive participants	2011-01-01	65
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	65
Number of participants with account balances	2011-01-01	65
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on KEYSTONE EYE ASSOCIATES, LLC PLAN

Measure	Date	Value
2022 : KEYSTONE EYE ASSOCIATES, LLC PLAN 2022 401k financial data
Transfers to/from the plan	2022-06-28	$0
Total plan liabilities at end of year	2022-06-28	$0
Total plan liabilities at beginning of year	2022-06-28	$0
Total income from all sources	2022-06-28	$-58,097
Expenses. Total of all expenses incurred	2022-06-28	$3,011,226
Benefits paid (including direct rollovers)	2022-06-28	$3,012,587
Total plan assets at end of year	2022-06-28	$0
Total plan assets at beginning of year	2022-06-28	$3,069,323
Value of fidelity bond covering the plan	2022-06-28	$400,000
Total contributions received or receivable from participants	2022-06-28	$0
Expenses. Other expenses not covered elsewhere	2022-06-28	$0
Contributions received from other sources (not participants or employers)	2022-06-28	$0
Other income received	2022-06-28	$-103,613
Noncash contributions received	2022-06-28	$0
Net income (gross income less expenses)	2022-06-28	$-3,069,323
Net plan assets at end of year (total assets less liabilities)	2022-06-28	$0
Net plan assets at beginning of year (total assets less liabilities)	2022-06-28	$3,069,323
Assets. Value of participant loans	2022-06-28	$0
Total contributions received or receivable from employer(s)	2022-06-28	$45,516
Value of certain deemed distributions of participant loans	2022-06-28	$-2,084
Value of corrective distributions	2022-06-28	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2022-06-28	$723
2021 : KEYSTONE EYE ASSOCIATES, LLC 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	$388,721
Expenses. Total of all expenses incurred	2021-12-31	$85,050
Benefits paid (including direct rollovers)	2021-12-31	$81,907
Total plan assets at end of year	2021-12-31	$3,069,323
Total plan assets at beginning of year	2021-12-31	$2,765,652
Value of fidelity bond covering the plan	2021-12-31	$400,000
Assets. Value of tangible personal property	2021-12-31	$0
Total contributions received or receivable from participants	2021-12-31	$117,729
Assets. Value of loans (other than to participants)	2021-12-31	$0
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	$216,164
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$303,671
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$3,069,323
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$2,765,652
Assets. Value of participant loans	2021-12-31	$3,000
Assets. Value of assets in partnership/joint-venture interests	2021-12-31	$0
Assets. Value of real-estate (other than employer real property)	2021-12-31	$0
Assets. Value of employer securities	2021-12-31	$0
Assets. Value of employer real property	2021-12-31	$0
Total contributions received or receivable from employer(s)	2021-12-31	$54,828
Value of certain deemed distributions of participant loans	2021-12-31	$2,118
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$1,025
2020 : KEYSTONE EYE ASSOCIATES, LLC 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	$476,948
Expenses. Total of all expenses incurred	2020-12-31	$144,514
Benefits paid (including direct rollovers)	2020-12-31	$138,791
Total plan assets at end of year	2020-12-31	$2,765,652
Total plan assets at beginning of year	2020-12-31	$2,433,218
Value of fidelity bond covering the plan	2020-12-31	$400,000
Assets. Value of tangible personal property	2020-12-31	$0
Total contributions received or receivable from participants	2020-12-31	$122,841
Assets. Value of loans (other than to participants)	2020-12-31	$0
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	$291,218
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$332,434
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$2,765,652
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$2,433,218
Assets. Value of participant loans	2020-12-31	$2,453
Assets. Value of assets in partnership/joint-venture interests	2020-12-31	$0
Assets. Value of real-estate (other than employer real property)	2020-12-31	$0
Assets. Value of employer securities	2020-12-31	$0
Assets. Value of employer real property	2020-12-31	$0
Total contributions received or receivable from employer(s)	2020-12-31	$62,889
Value of certain deemed distributions of participant loans	2020-12-31	$5,236
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$487
2019 : KEYSTONE EYE ASSOCIATES, LLC 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	$453,817
Expenses. Total of all expenses incurred	2019-12-31	$33,956
Benefits paid (including direct rollovers)	2019-12-31	$33,735
Total plan assets at end of year	2019-12-31	$2,433,218
Total plan assets at beginning of year	2019-12-31	$2,013,357
Value of fidelity bond covering the plan	2019-12-31	$400,000
Total contributions received or receivable from participants	2019-12-31	$114,916
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	$288,787
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$419,861
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$2,433,218
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$2,013,357
Assets. Value of participant loans	2019-12-31	$9,044
Total contributions received or receivable from employer(s)	2019-12-31	$50,114
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	$221
2018 : KEYSTONE EYE ASSOCIATES, LLC 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	$34,007
Expenses. Total of all expenses incurred	2018-12-31	$91,278
Benefits paid (including direct rollovers)	2018-12-31	$91,233
Total plan assets at end of year	2018-12-31	$2,013,357
Total plan assets at beginning of year	2018-12-31	$2,070,628
Value of fidelity bond covering the plan	2018-12-31	$400,000
Total contributions received or receivable from participants	2018-12-31	$90,476
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	$-86,439
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$-57,271
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$2,013,357
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$2,070,628
Assets. Value of participant loans	2018-12-31	$168
Total contributions received or receivable from employer(s)	2018-12-31	$29,970
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	$45
2017 : KEYSTONE EYE ASSOCIATES, LLC 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	$318,966
Expenses. Total of all expenses incurred	2017-12-31	$69,015
Benefits paid (including direct rollovers)	2017-12-31	$68,868
Total plan assets at end of year	2017-12-31	$2,070,628
Total plan assets at beginning of year	2017-12-31	$1,820,677
Value of fidelity bond covering the plan	2017-12-31	$400,000
Assets. Value of tangible personal property	2017-12-31	$0
Total contributions received or receivable from participants	2017-12-31	$62,382
Assets. Value of loans (other than to participants)	2017-12-31	$0
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	$222,189
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$249,951
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$2,070,628
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$1,820,677
Assets. Value of participant loans	2017-12-31	$1,652
Assets. Value of assets in partnership/joint-venture interests	2017-12-31	$0
Assets. Value of real-estate (other than employer real property)	2017-12-31	$0
Assets. Value of employer securities	2017-12-31	$0
Assets. Value of employer real property	2017-12-31	$0
Total contributions received or receivable from employer(s)	2017-12-31	$34,395
Value of certain deemed distributions of participant loans	2017-12-31	$28
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$119
2016 : KEYSTONE EYE ASSOCIATES, LLC 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	$185,034
Expenses. Total of all expenses incurred	2016-12-31	$110,640
Benefits paid (including direct rollovers)	2016-12-31	$110,615
Total plan assets at end of year	2016-12-31	$1,820,677
Total plan assets at beginning of year	2016-12-31	$1,746,283
Value of fidelity bond covering the plan	2016-12-31	$400,000
Total contributions received or receivable from participants	2016-12-31	$64,072
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	$82,955
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$74,394
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,820,677
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,746,283
Assets. Value of participant loans	2016-12-31	$2,474
Total contributions received or receivable from employer(s)	2016-12-31	$38,007
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	$25
2015 : KEYSTONE EYE ASSOCIATES, LLC 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	$91,620
Expenses. Total of all expenses incurred	2015-12-31	$1,193,593
Benefits paid (including direct rollovers)	2015-12-31	$1,193,210
Total plan assets at end of year	2015-12-31	$1,746,283
Total plan assets at beginning of year	2015-12-31	$2,848,256
Value of fidelity bond covering the plan	2015-12-31	$400,000
Total contributions received or receivable from participants	2015-12-31	$54,143
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	$5,082
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-1,101,973
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,746,283
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$2,848,256
Assets. Value of participant loans	2015-12-31	$4,552
Total contributions received or receivable from employer(s)	2015-12-31	$32,395
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	$383
2014 : KEYSTONE EYE ASSOCIATES, LLC PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$242,575
Expenses. Total of all expenses incurred	2014-12-31	$195,630
Benefits paid (including direct rollovers)	2014-12-31	$195,176
Total plan assets at end of year	2014-12-31	$2,848,256
Total plan assets at beginning of year	2014-12-31	$2,801,311
Value of fidelity bond covering the plan	2014-12-31	$400,000
Total contributions received or receivable from participants	2014-12-31	$55,048
Expenses. Other expenses not covered elsewhere	2014-12-31	$454
Contributions received from other sources (not participants or employers)	2014-12-31	$950
Other income received	2014-12-31	$141,802
Net income (gross income less expenses)	2014-12-31	$46,945
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$2,848,256
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$2,801,311
Assets. Value of participant loans	2014-12-31	$14,906
Total contributions received or receivable from employer(s)	2014-12-31	$44,775
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
2013 : KEYSTONE EYE ASSOCIATES, LLC PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$9
Total income from all sources	2013-12-31	$539,355
Expenses. Total of all expenses incurred	2013-12-31	$202,020
Benefits paid (including direct rollovers)	2013-12-31	$201,062
Total plan assets at end of year	2013-12-31	$2,801,311
Total plan assets at beginning of year	2013-12-31	$2,463,967
Value of fidelity bond covering the plan	2013-12-31	$400,000
Total contributions received or receivable from participants	2013-12-31	$60,463
Expenses. Other expenses not covered elsewhere	2013-12-31	$958
Contributions received from other sources (not participants or employers)	2013-12-31	$11,165
Other income received	2013-12-31	$407,631
Net income (gross income less expenses)	2013-12-31	$337,335
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,801,311
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,463,967
Assets. Value of participant loans	2013-12-31	$16,150
Total contributions received or receivable from employer(s)	2013-12-31	$60,096
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2013-12-31	$0
Minimum employer required contribution for this plan year	2013-12-31	$0
Amount contributed by the employer to the plan for this plan year	2013-12-31	$0
2012 : KEYSTONE EYE ASSOCIATES, LLC PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$22
Total income from all sources	2012-12-31	$365,560
Expenses. Total of all expenses incurred	2012-12-31	$44,122
Benefits paid (including direct rollovers)	2012-12-31	$43,374
Total plan assets at end of year	2012-12-31	$2,463,967
Total plan assets at beginning of year	2012-12-31	$2,142,507
Value of fidelity bond covering the plan	2012-12-31	$400,000
Total contributions received or receivable from participants	2012-12-31	$123,612
Expenses. Other expenses not covered elsewhere	2012-12-31	$748
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$179,698
Net income (gross income less expenses)	2012-12-31	$321,438
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,463,967
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,142,507
Assets. Value of participant loans	2012-12-31	$33,008
Total contributions received or receivable from employer(s)	2012-12-31	$62,250
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2012-12-31	$0
Minimum employer required contribution for this plan year	2012-12-31	$0
Amount contributed by the employer to the plan for this plan year	2012-12-31	$0
2011 : KEYSTONE EYE ASSOCIATES, LLC PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$157,639
Expenses. Total of all expenses incurred	2011-12-31	$82,521
Benefits paid (including direct rollovers)	2011-12-31	$81,836
Total plan assets at end of year	2011-12-31	$2,142,507
Total plan assets at beginning of year	2011-12-31	$2,067,389
Value of fidelity bond covering the plan	2011-12-31	$400,000
Total contributions received or receivable from participants	2011-12-31	$124,416
Expenses. Other expenses not covered elsewhere	2011-12-31	$685
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-36,414
Net income (gross income less expenses)	2011-12-31	$75,118
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,142,507
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,067,389
Assets. Value of participant loans	2011-12-31	$40,063
Total contributions received or receivable from employer(s)	2011-12-31	$69,637
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : KEYSTONE EYE ASSOCIATES, LLC PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$285,858
Expenses. Total of all expenses incurred	2010-12-31	$243,011
Benefits paid (including direct rollovers)	2010-12-31	$242,587
Total plan assets at end of year	2010-12-31	$2,067,389
Total plan assets at beginning of year	2010-12-31	$2,024,542
Value of fidelity bond covering the plan	2010-12-31	$400,000
Total contributions received or receivable from participants	2010-12-31	$123,264
Expenses. Other expenses not covered elsewhere	2010-12-31	$424
Contributions received from other sources (not participants or employers)	2010-12-31	$7,712
Other income received	2010-12-31	$154,882
Net income (gross income less expenses)	2010-12-31	$42,847
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,067,389
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,024,542
Assets. Value of participant loans	2010-12-31	$24,903
Total contributions received or receivable from employer(s)	2010-12-31	$0
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0

Form 5500 Responses for KEYSTONE EYE ASSOCIATES, LLC PLAN

2022: KEYSTONE EYE ASSOCIATES, LLC PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	Yes
2022-01-01	This submission is the final filing	Yes
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: KEYSTONE EYE ASSOCIATES, LLC 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: KEYSTONE EYE ASSOCIATES, LLC PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	This submission is the final filing	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: KEYSTONE EYE ASSOCIATES, LLC 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: KEYSTONE EYE ASSOCIATES, LLC 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: KEYSTONE EYE ASSOCIATES, LLC 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	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: KEYSTONE EYE ASSOCIATES, LLC 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: KEYSTONE EYE ASSOCIATES, LLC PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: KEYSTONE EYE ASSOCIATES, LLC PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: KEYSTONE EYE ASSOCIATES, LLC PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: KEYSTONE EYE ASSOCIATES, LLC 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
2011: KEYSTONE EYE ASSOCIATES, LLC 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

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-820610

Policy instance

Insurance contract or identification number	GA-820610
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $4,120
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?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,120
Amount paid for insurance broker fees	0
Insurance broker name	LINCOLN INVESTMENT PLANNING INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-820610

Policy instance

Insurance contract or identification number	GA-820610
Number of Individuals Covered	58
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $5,482
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,482
Insurance broker organization code?	3
Insurance broker name	LINCOLN INVESTMENT PLANNING INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-820610

Policy instance

Insurance contract or identification number	GA-820610
Number of Individuals Covered	53
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,694
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,694
Insurance broker organization code?	3
Insurance broker name	LINCOLN INVESTMENT PLANNING

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-820610

Policy instance

Insurance contract or identification number	GA-820610
Number of Individuals Covered	29
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,379
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,244
Insurance broker organization code?	3
Insurance broker name	CAPITAL ANALYSTS INC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-820610

Policy instance

Insurance contract or identification number	GA-820610
Number of Individuals Covered	65
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,396
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-820610

Policy instance

Insurance contract or identification number	GA-820610
Number of Individuals Covered	69
Insurance policy start date	2010-03-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $31,824
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $31,824
Insurance broker organization code?	3
Insurance broker name	CAPITAL ANALYSTS INC

Potentially related plans

KEYSTONE EYE CARE GROUP, LLC 401(K) PLAN AND TRUST [EIN = 203266125]

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Company Name:	KEYSTONE EYE ASSOCIATES, LLC
Employer identification number (EIN):	200864522
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE
Incorporation Date:
Company Identification Number:	3196440