401k Plan data: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP plan

LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 401k Plan overview

Plan Name	LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP
Plan identification number	001

LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 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.
Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan covering Self-Employed individuals.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

LARRY D OXENBERG OD has sponsored the creation of one or more 401k plans.

Company Name: LARRY D OXENBERG OD

Employer identification number (EIN): 232607578

NAIC Classification: 621320
NAIC Description: Offices of Optometrists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01 LARRY OXENBERG 2022-07-11
001 2020-01-01 LARRY OXENBERG 2021-05-14
001 2019-01-01 LARRY OXENBERG 2020-01-28
001 2018-01-01 LARRY OXENBERG 2019-03-18
001 2017-01-01 LARRY OXENBERG 2018-02-05
001 2016-01-01 LARRY OXENBERG 2017-04-05
001 2015-01-01 LARRY OXENBERG 2016-08-22
001 2014-01-01 LARRY OXENBERG, OD, TRUSTEE
001 2013-01-01 LARRY OXENBERG, OD, TRUSTEE
001 2012-01-01 LARRY OXENBERG, OD, TRUSTEE
001 2011-01-01 LARRY OXENBERG, OD, TRUSTEE
001 2009-01-01 LARRY OXENBERG, OD, TRUSTEE

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
001	2021-01-01	LARRY OXENBERG	2022-07-11
001	2020-01-01	LARRY OXENBERG	2021-05-14
001	2019-01-01	LARRY OXENBERG	2020-01-28
001	2018-01-01	LARRY OXENBERG	2019-03-18
001	2017-01-01	LARRY OXENBERG	2018-02-05
001	2016-01-01	LARRY OXENBERG	2017-04-05
001	2015-01-01	LARRY OXENBERG	2016-08-22
001	2014-01-01	LARRY OXENBERG, OD, TRUSTEE
001	2013-01-01	LARRY OXENBERG, OD, TRUSTEE
001	2012-01-01	LARRY OXENBERG, OD, TRUSTEE
001	2011-01-01	LARRY OXENBERG, OD, TRUSTEE
001	2009-01-01	LARRY OXENBERG, OD, TRUSTEE

Plan Statistics for LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP

401k plan membership statisitcs for LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP

Measure Date Value
2014: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2014 401k membership
Total participants, beginning-of-year 2014-01-01 5
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 5
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 0
Total of all active and inactive participants 2014-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 5
Number of participants with account balances 2014-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2013 401k membership
Total participants, beginning-of-year 2013-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 5
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 5
Number of participants with account balances 2013-01-01 5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2012 401k membership
Total participants, beginning-of-year 2012-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 4
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 4
Number of participants with account balances 2012-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2011 401k membership
Total participants, beginning-of-year 2011-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
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 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 6
Number of participants with account balances 2011-01-01 6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2009 401k membership
Total participants, beginning-of-year 2009-01-01 6
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 4
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 2
Total of all active and inactive participants 2009-01-01 6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 6
Number of participants with account balances 2009-01-01 6

Measure	Date	Value
2014: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2014 401k membership
Total participants, beginning-of-year	2014-01-01	5
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	5
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	0
Total of all active and inactive participants	2014-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	5
Number of participants with account balances	2014-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2013 401k membership
Total participants, beginning-of-year	2013-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	5
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	5
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	5
Number of participants with account balances	2013-01-01	5
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2012 401k membership
Total participants, beginning-of-year	2012-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	4
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	4
Number of participants with account balances	2012-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2011 401k membership
Total participants, beginning-of-year	2011-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
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	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	6
Number of participants with account balances	2011-01-01	6
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2009 401k membership
Total participants, beginning-of-year	2009-01-01	6
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	4
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	2
Total of all active and inactive participants	2009-01-01	6
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	6
Number of participants with account balances	2009-01-01	6

Financial Data on LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP

Measure	Date	Value
2014 : LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2014 401k financial data
Total income from all sources	2014-12-31	$100,014
Expenses. Total of all expenses incurred	2014-12-31	$1,839
Total plan assets at end of year	2014-12-31	$940,132
Total plan assets at beginning of year	2014-12-31	$841,957
Value of fidelity bond covering the plan	2014-12-31	$100,000
Total contributions received or receivable from participants	2014-12-31	$34,673
Other income received	2014-12-31	$21,900
Net income (gross income less expenses)	2014-12-31	$98,175
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$940,132
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$841,957
Total contributions received or receivable from employer(s)	2014-12-31	$43,441
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$1,839
2013 : LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2013 401k financial data
Total income from all sources	2013-12-31	$143,007
Total plan assets at end of year	2013-12-31	$841,957
Total plan assets at beginning of year	2013-12-31	$698,950
Value of fidelity bond covering the plan	2013-12-31	$100,000
Total contributions received or receivable from participants	2013-12-31	$34,532
Other income received	2013-12-31	$65,555
Net income (gross income less expenses)	2013-12-31	$143,007
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$841,957
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$698,950
Total contributions received or receivable from employer(s)	2013-12-31	$42,920
2012 : LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2012 401k financial data
Total income from all sources	2012-12-31	$106,656
Total plan assets at end of year	2012-12-31	$698,950
Total plan assets at beginning of year	2012-12-31	$592,294
Value of fidelity bond covering the plan	2012-12-31	$100,000
Total contributions received or receivable from participants	2012-12-31	$33,839
Other income received	2012-12-31	$32,286
Net income (gross income less expenses)	2012-12-31	$106,656
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$698,950
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$592,294
Total contributions received or receivable from employer(s)	2012-12-31	$40,531
2011 : LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2011 401k financial data
Total income from all sources	2011-12-31	$63,331
Total plan assets at end of year	2011-12-31	$592,294
Total plan assets at beginning of year	2011-12-31	$528,963
Value of fidelity bond covering the plan	2011-12-31	$100,000
Total contributions received or receivable from participants	2011-12-31	$32,640
Other income received	2011-12-31	$-9,052
Net income (gross income less expenses)	2011-12-31	$63,331
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$592,294
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$528,963
Total contributions received or receivable from employer(s)	2011-12-31	$39,743
2010 : LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2010 401k financial data
Total income from all sources	2010-12-31	$99,457
Expenses. Total of all expenses incurred	2010-12-31	$11,212
Benefits paid (including direct rollovers)	2010-12-31	$11,212
Total plan assets at end of year	2010-12-31	$528,963
Total plan assets at beginning of year	2010-12-31	$440,718
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$30,557
Other income received	2010-12-31	$31,450
Net income (gross income less expenses)	2010-12-31	$88,245
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$528,963
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$440,718
Total contributions received or receivable from employer(s)	2010-12-31	$37,450

Form 5500 Responses for LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP

2014: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
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: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
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: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
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: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
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
2009: LARRY OXENBERG, OD ROTH SAFE-HARBOR 401-K PSP 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

0475386

Policy instance

Insurance contract or identification number	0475386
Number of Individuals Covered	1
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	PRINCIPAL GUARANTEE
Insurance broker name	RICHARD M BRAVERMAN

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

1005704754

Policy instance

Insurance contract or identification number	1005704754
Number of Individuals Covered	1
Insurance policy start date	2013-07-26
Insurance policy end date	2014-07-25
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	GENEOS WEALTH MANAGEMENT

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

0398679

Policy instance

Insurance contract or identification number	0398679
Number of Individuals Covered	5
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	SAMUEL MONCHIK

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 79065 )

Policy contract number

KA12606530-01

Policy instance

Insurance contract or identification number	KA12606530-01
Insurance policy start date	2013-05-12
Insurance policy end date	2013-05-24
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	3
Insurance broker name	FSC AGENCY INC

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

0398679

Policy instance

Insurance contract or identification number	0398679
Number of Individuals Covered	5
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	SAMUEL MONCHIK

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

0475386

Policy instance

Insurance contract or identification number	0475386
Number of Individuals Covered	1
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	PRINCIPAL GUARANTEE
Insurance broker name	RICHARD M BRAVERMAN

JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )

Policy contract number

1005704754

Policy instance

Insurance contract or identification number	1005704754
Number of Individuals Covered	1
Insurance policy start date	2012-07-22
Insurance policy end date	2013-07-22
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	GENEOS WEALTH MANAGEMENT

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 79065 )

Policy contract number

KA12606530-01

Policy instance

Insurance contract or identification number	KA12606530-01
Number of Individuals Covered	1
Insurance policy start date	2012-05-12
Insurance policy end date	2013-05-12
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Additional information about fees paid to insurance broker	3
Insurance broker name	FSC AGENCY INC

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

0475386

Policy instance

Insurance contract or identification number	0475386
Number of Individuals Covered	1
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	PRINCIPAL GUARANTEE
Insurance broker name	RICHARD M BRAVERMAN

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

0398679

Policy instance

Insurance contract or identification number	0398679
Number of Individuals Covered	5
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	SAMUEL MONCHIK

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 79065 )

Policy contract number

KA12606530-01

Policy instance

Insurance contract or identification number	KA12606530-01
Number of Individuals Covered	1
Insurance policy start date	2011-05-12
Insurance policy end date	2012-05-12
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

0398679

Policy instance

Insurance contract or identification number	0398679
Number of Individuals Covered	5
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

0475386

Policy instance

Insurance contract or identification number	0475386
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	PRINCIPAL GUARANTEE

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 79065 )

Policy contract number

KA12606530-01

Policy instance

Insurance contract or identification number	KA12606530-01
Number of Individuals Covered	1
Insurance policy start date	2009-05-12
Insurance policy end date	2010-05-12
Are there contracts with allocated funds for individual policies?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	FSC AGENCY INC

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

0398679

Policy instance

Insurance contract or identification number	0398679
Number of Individuals Covered	5
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker name	SAMUEL MONCHIK

METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )

Policy contract number

0475386

Policy instance

Insurance contract or identification number	0475386
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Are there contracts with allocated funds for types other than group deferred annuity or individual?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Other information about contract	PRINCIPAL GUARANTEE
Insurance broker name	RICHARD M BRAVERMAN

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Company Name:	LARRY D OXENBERG OD
Employer identification number (EIN):	232607578
NAIC Classification:	621320
NAIC Description:	Offices of Optometrists