401k Plan data: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN plan

ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN
Plan identification number	001

ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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

ADA WEST DERMATOLOGY, P.C. has sponsored the creation of one or more 401k plans.

Company Name: ADA WEST DERMATOLOGY, P.C.

Employer identification number (EIN): 203276415

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ADA WEST DERMATOLOGY 401(K) PROFIT SHARING 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
001 2017-01-01 RANDALL BURR
001 2016-01-01 RANDALL BURR
001 2015-01-01 RANDALL BURR
001 2014-01-01 RANDALL BURR
001 2013-01-01 RANDALL BURR
001 2012-01-01 RANDALL BURR
001 2011-01-01 RANDALL BURR
001 2010-01-01 RANDALL BURR
001 2009-01-01 RANDALL D. BURR RANDALL D. BURR 2010-09-09
001 2009-01-01 RANDALL D. BURR RANDALL D. BURR 2010-09-16

Plan Statistics for ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN

Measure Date Value
2022: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 118
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 97
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 18
Total of all active and inactive participants 2022-01-01 115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 1
Total participants 2022-01-01 116
Number of participants with account balances 2022-01-01 101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 9
2021: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 99
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 95
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 18
Total of all active and inactive participants 2021-01-01 113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 114
Number of participants with account balances 2021-01-01 112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 9
2020: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 92
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 80
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 11
Total of all active and inactive participants 2020-01-01 91
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 91
Number of participants with account balances 2020-01-01 91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 7
2019: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 79
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 10
Total of all active and inactive participants 2019-01-01 89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 89
Number of participants with account balances 2019-01-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 5
2018: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 80
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 63
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 71
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 71
Number of participants with account balances 2018-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 7
2017: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 67
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 62
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 10
Total of all active and inactive participants 2017-01-01 72
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 72
Number of participants with account balances 2017-01-01 72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 6
2016: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 67
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 54
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 6
Total of all active and inactive participants 2016-01-01 60
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 60
Number of participants with account balances 2016-01-01 58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 8
2015: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 61
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 55
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 10
Total of all active and inactive participants 2015-01-01 65
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 65
Number of participants with account balances 2015-01-01 64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 8
2014: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 51
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 55
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 58
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 58
Number of participants with account balances 2014-01-01 57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 4
2013: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 39
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 2
Total of all active and inactive participants 2013-01-01 41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 1
Total participants 2013-01-01 42
Number of participants with account balances 2013-01-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 3
2012: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 31
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 29
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 1
Total of all active and inactive participants 2012-01-01 31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 31
Number of participants with account balances 2012-01-01 31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 27
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 2
Total of all active and inactive participants 2011-01-01 29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 29
Number of participants with account balances 2011-01-01 29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 1
2010: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 27
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 25
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 3
Total of all active and inactive participants 2010-01-01 28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 28
Number of participants with account balances 2010-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 1
2009: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 25
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 1
Total of all active and inactive participants 2009-01-01 26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 26
Number of participants with account balances 2009-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2022: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	118
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	97
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	18
Total of all active and inactive participants	2022-01-01	115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	1
Total participants	2022-01-01	116
Number of participants with account balances	2022-01-01	101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	9
2021: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	99
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	95
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	18
Total of all active and inactive participants	2021-01-01	113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	114
Number of participants with account balances	2021-01-01	112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	9
2020: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	92
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	80
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	11
Total of all active and inactive participants	2020-01-01	91
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	91
Number of participants with account balances	2020-01-01	91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	7
2019: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	79
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	10
Total of all active and inactive participants	2019-01-01	89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	89
Number of participants with account balances	2019-01-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	5
2018: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	80
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	63
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	71
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	71
Number of participants with account balances	2018-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	7
2017: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	67
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	62
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	10
Total of all active and inactive participants	2017-01-01	72
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	72
Number of participants with account balances	2017-01-01	72
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	6
2016: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	67
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	54
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	6
Total of all active and inactive participants	2016-01-01	60
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	60
Number of participants with account balances	2016-01-01	58
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	8
2015: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	61
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	55
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	10
Total of all active and inactive participants	2015-01-01	65
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	65
Number of participants with account balances	2015-01-01	64
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	8
2014: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	51
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	55
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	58
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	58
Number of participants with account balances	2014-01-01	57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	4
2013: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	39
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	2
Total of all active and inactive participants	2013-01-01	41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	42
Number of participants with account balances	2013-01-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	3
2012: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	29
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	1
Total of all active and inactive participants	2012-01-01	31
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	31
Number of participants with account balances	2012-01-01	31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	27
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	2
Total of all active and inactive participants	2011-01-01	29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	29
Number of participants with account balances	2011-01-01	29
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	1
2010: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	25
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	3
Total of all active and inactive participants	2010-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	28
Number of participants with account balances	2010-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	1
2009: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	25
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	1
Total of all active and inactive participants	2009-01-01	26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	26
Number of participants with account balances	2009-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2022 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total income from all sources	2022-12-31	$-2,008,718
Expenses. Total of all expenses incurred	2022-12-31	$1,575,076
Benefits paid (including direct rollovers)	2022-12-31	$1,548,143
Total plan assets at end of year	2022-12-31	$9,404,982
Total plan assets at beginning of year	2022-12-31	$12,988,776
Value of fidelity bond covering the plan	2022-12-31	$500,000
Total contributions received or receivable from participants	2022-12-31	$495,323
Contributions received from other sources (not participants or employers)	2022-12-31	$10,081
Other income received	2022-12-31	$-2,514,122
Net income (gross income less expenses)	2022-12-31	$-3,583,794
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$9,404,982
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$12,988,776
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$26,933
2021 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources	2021-12-31	$3,086,782
Expenses. Total of all expenses incurred	2021-12-31	$1,638,373
Benefits paid (including direct rollovers)	2021-12-31	$1,614,622
Total plan assets at end of year	2021-12-31	$12,988,776
Total plan assets at beginning of year	2021-12-31	$11,540,367
Value of fidelity bond covering the plan	2021-12-31	$500,000
Total contributions received or receivable from participants	2021-12-31	$399,359
Contributions received from other sources (not participants or employers)	2021-12-31	$86,274
Other income received	2021-12-31	$2,010,634
Net income (gross income less expenses)	2021-12-31	$1,448,409
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$12,988,776
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$11,540,367
Total contributions received or receivable from employer(s)	2021-12-31	$590,515
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$23,751
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
2020 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources	2020-12-31	$2,487,153
Expenses. Total of all expenses incurred	2020-12-31	$48,940
Benefits paid (including direct rollovers)	2020-12-31	$47,263
Total plan assets at end of year	2020-12-31	$11,540,367
Total plan assets at beginning of year	2020-12-31	$9,102,154
Value of fidelity bond covering the plan	2020-12-31	$500,000
Total contributions received or receivable from participants	2020-12-31	$360,234
Other income received	2020-12-31	$1,590,460
Net income (gross income less expenses)	2020-12-31	$2,438,213
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$11,540,367
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$9,102,154
Total contributions received or receivable from employer(s)	2020-12-31	$536,459
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$1,677
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$2,587,909
Expenses. Total of all expenses incurred	2019-12-31	$8,815
Benefits paid (including direct rollovers)	2019-12-31	$971
Total plan assets at end of year	2019-12-31	$9,102,154
Total plan assets at beginning of year	2019-12-31	$6,523,060
Value of fidelity bond covering the plan	2019-12-31	$500,000
Total contributions received or receivable from participants	2019-12-31	$383,052
Contributions received from other sources (not participants or employers)	2019-12-31	$162,003
Other income received	2019-12-31	$1,550,693
Net income (gross income less expenses)	2019-12-31	$2,579,094
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$9,102,154
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$6,523,060
Total contributions received or receivable from employer(s)	2019-12-31	$492,161
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$7,844
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$402,532
Expenses. Total of all expenses incurred	2018-12-31	$92,747
Benefits paid (including direct rollovers)	2018-12-31	$81,812
Total plan assets at end of year	2018-12-31	$6,523,060
Total plan assets at beginning of year	2018-12-31	$6,213,275
Value of fidelity bond covering the plan	2018-12-31	$500,000
Total contributions received or receivable from participants	2018-12-31	$313,166
Other income received	2018-12-31	$-377,632
Net income (gross income less expenses)	2018-12-31	$309,785
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$6,523,060
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$6,213,275
Total contributions received or receivable from employer(s)	2018-12-31	$466,998
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$10,935
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$1,523,579
Expenses. Total of all expenses incurred	2017-12-31	$21,909
Benefits paid (including direct rollovers)	2017-12-31	$20,458
Total plan assets at end of year	2017-12-31	$6,213,275
Total plan assets at beginning of year	2017-12-31	$4,711,605
Value of fidelity bond covering the plan	2017-12-31	$500,000
Total contributions received or receivable from participants	2017-12-31	$240,663
Contributions received from other sources (not participants or employers)	2017-12-31	$6,910
Other income received	2017-12-31	$853,148
Net income (gross income less expenses)	2017-12-31	$1,501,670
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$6,213,275
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$4,711,605
Total contributions received or receivable from employer(s)	2017-12-31	$422,858
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$1,451
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$948,969
Expenses. Total of all expenses incurred	2016-12-31	$381,222
Benefits paid (including direct rollovers)	2016-12-31	$379,987
Total plan assets at end of year	2016-12-31	$4,711,605
Total plan assets at beginning of year	2016-12-31	$4,143,858
Value of fidelity bond covering the plan	2016-12-31	$500,000
Total contributions received or receivable from participants	2016-12-31	$239,782
Contributions received from other sources (not participants or employers)	2016-12-31	$7,387
Other income received	2016-12-31	$314,595
Net income (gross income less expenses)	2016-12-31	$567,747
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$4,711,605
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$4,143,858
Total contributions received or receivable from employer(s)	2016-12-31	$387,205
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$1,235
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$532,932
Expenses. Total of all expenses incurred	2015-12-31	$90,026
Benefits paid (including direct rollovers)	2015-12-31	$88,966
Total plan assets at end of year	2015-12-31	$4,143,858
Total plan assets at beginning of year	2015-12-31	$3,700,952
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$219,450
Other income received	2015-12-31	$-71,911
Net income (gross income less expenses)	2015-12-31	$442,906
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$4,143,858
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$3,700,952
Total contributions received or receivable from employer(s)	2015-12-31	$385,393
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$1,060
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$713,776
Expenses. Total of all expenses incurred	2014-12-31	$73,561
Benefits paid (including direct rollovers)	2014-12-31	$72,841
Total plan assets at end of year	2014-12-31	$3,700,952
Total plan assets at beginning of year	2014-12-31	$3,060,737
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$221,818
Other income received	2014-12-31	$165,458
Net income (gross income less expenses)	2014-12-31	$640,215
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$3,700,952
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$3,060,737
Total contributions received or receivable from employer(s)	2014-12-31	$326,500
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$720
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$906,456
Expenses. Total of all expenses incurred	2013-12-31	$345,283
Benefits paid (including direct rollovers)	2013-12-31	$344,658
Total plan assets at end of year	2013-12-31	$3,060,737
Total plan assets at beginning of year	2013-12-31	$2,499,564
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$154,245
Contributions received from other sources (not participants or employers)	2013-12-31	$49,619
Other income received	2013-12-31	$352,560
Net income (gross income less expenses)	2013-12-31	$561,173
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$3,060,737
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,499,564
Total contributions received or receivable from employer(s)	2013-12-31	$350,032
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$625
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$566,313
Expenses. Total of all expenses incurred	2012-12-31	$15,690
Benefits paid (including direct rollovers)	2012-12-31	$15,690
Total plan assets at end of year	2012-12-31	$2,499,564
Total plan assets at beginning of year	2012-12-31	$1,948,941
Value of fidelity bond covering the plan	2012-12-31	$300,000
Total contributions received or receivable from participants	2012-12-31	$121,688
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	$224,404
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$550,623
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,499,564
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,948,941
Total contributions received or receivable from employer(s)	2012-12-31	$220,221
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$275,199
Expenses. Total of all expenses incurred	2011-12-31	$13,118
Benefits paid (including direct rollovers)	2011-12-31	$4,351
Total plan assets at end of year	2011-12-31	$1,948,941
Total plan assets at beginning of year	2011-12-31	$1,686,860
Value of fidelity bond covering the plan	2011-12-31	$300,000
Total contributions received or receivable from participants	2011-12-31	$103,077
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-60,654
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$262,081
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,948,941
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,686,860
Total contributions received or receivable from employer(s)	2011-12-31	$232,776
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$8,427
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$340
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$367,021
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	$405,261
Expenses. Total of all expenses incurred	2010-12-31	$25,796
Benefits paid (including direct rollovers)	2010-12-31	$25,796
Total plan assets at end of year	2010-12-31	$1,686,860
Total plan assets at beginning of year	2010-12-31	$940,374
Value of fidelity bond covering the plan	2010-12-31	$60,000
Total contributions received or receivable from participants	2010-12-31	$63,994
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	$124,655
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$379,465
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,686,860
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$940,374
Total contributions received or receivable from employer(s)	2010-12-31	$216,612
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN

2022: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
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: ADA WEST DERMATOLOGY 401(K) 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: ADA WEST DERMATOLOGY 401(K) 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: ADA WEST DERMATOLOGY 401(K) 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: ADA WEST DERMATOLOGY 401(K) 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: ADA WEST DERMATOLOGY 401(K) 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 – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: ADA WEST DERMATOLOGY 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

106064

Policy instance

Insurance contract or identification number	106064
Number of Individuals Covered	0
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $6,121
Total amount of fees paid to insurance company	USD $283
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,121
Insurance broker organization code?	3
Amount paid for insurance broker fees	283
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	PINNACLE PENSION SERVICES

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

Policy contract number

106064

Policy instance

Insurance contract or identification number	106064
Number of Individuals Covered	52
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $14,963
Total amount of fees paid to insurance company	USD $1,060
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 $14,963
Insurance broker organization code?	3
Amount paid for insurance broker fees	1060
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	PINNACLE PENSION SERVICES

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

Policy contract number

106064

Policy instance

Insurance contract or identification number	106064
Number of Individuals Covered	47
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $12,632
Total amount of fees paid to insurance company	USD $720
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 $12,632
Insurance broker organization code?	3
Amount paid for insurance broker fees	720
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	PINNACLE PENSION SERVICES

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

Policy contract number

106064

Policy instance

Insurance contract or identification number	106064
Number of Individuals Covered	37
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,922
Total amount of fees paid to insurance company	USD $625
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 $8,922
Insurance broker organization code?	3
Amount paid for insurance broker fees	625
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker name	PINNACLE PENSION SERVICES

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G36020

Policy instance

Insurance contract or identification number	G36020
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-06-25
Total amount of commissions paid to insurance broker	USD $4,112
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 $1,398
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	ERIC DITTMAN

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

Policy contract number

106064

Policy instance

Insurance contract or identification number	106064
Number of Individuals Covered	28
Insurance policy start date	2012-06-25
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $21,451
Total amount of fees paid to insurance company	USD $1,111
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 $21,451
Amount paid for insurance broker fees	676
Additional information about fees paid to insurance broker	OTHER ALLOWANCES
Insurance broker organization code?	3
Insurance broker name	PINNACLE PENSION SERVICES

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G36020

Policy instance

Insurance contract or identification number	G36020
Number of Individuals Covered	26
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,812
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

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Company Name:	ADA WEST DERMATOLOGY, P.C.
Employer identification number (EIN):	203276415
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)