401k Plan data: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN plan

SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 401k Plan overview

Plan Name	SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN
Plan identification number	001

SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
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

SIDDONS-MARTIN EMERGENCY GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: SIDDONS-MARTIN EMERGENCY GROUP, LLC

Employer identification number (EIN): 274333590

NAIC Classification: 621900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SIDDONS MARTIN EMERGENCY GROUP 401(K) 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 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01 JEFF KEISER
001 2017-01-01
001 2016-01-01 JEFF KEISER 2017-10-04
001 2016-01-01
001 2015-01-01 JEFF KEISER 2016-10-11
001 2014-01-01 JEFF KEISER 2015-11-02
001 2013-01-01 JEFFREY KEISER 2014-10-15

Plan Statistics for SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN

401k plan membership statisitcs for SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN

Measure Date Value
2022: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 419
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 480
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 22
Total of all active and inactive participants 2022-01-01 502
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 502
Number of participants with account balances 2022-01-01 478
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 307
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 324
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 23
Total of all active and inactive participants 2021-01-01 347
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 1
Total participants 2021-01-01 348
Number of participants with account balances 2021-01-01 331
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 279
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 304
Number of retired or separated participants receiving benefits 2020-01-01 2
Number of other retired or separated participants entitled to future benefits 2020-01-01 11
Total of all active and inactive participants 2020-01-01 317
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 317
Number of participants with account balances 2020-01-01 294
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 231
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 248
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 24
Total of all active and inactive participants 2019-01-01 272
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 272
Number of participants with account balances 2019-01-01 149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 1
2018: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 219
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 208
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 20
Total of all active and inactive participants 2018-01-01 228
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 228
Number of participants with account balances 2018-01-01 109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 6
2017: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 119
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 203
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 16
Total of all active and inactive participants 2017-01-01 219
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 219
Number of participants with account balances 2017-01-01 102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 5
2016: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 147
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 173
Number of retired or separated participants receiving benefits 2016-01-01 2
Number of other retired or separated participants entitled to future benefits 2016-01-01 8
Total of all active and inactive participants 2016-01-01 183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 183
Number of participants with account balances 2016-01-01 71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 1

Measure	Date	Value
2022: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	419
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	480
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	22
Total of all active and inactive participants	2022-01-01	502
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	502
Number of participants with account balances	2022-01-01	478
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	307
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	324
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	23
Total of all active and inactive participants	2021-01-01	347
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	1
Total participants	2021-01-01	348
Number of participants with account balances	2021-01-01	331
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	279
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	304
Number of retired or separated participants receiving benefits	2020-01-01	2
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	317
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	317
Number of participants with account balances	2020-01-01	294
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	231
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	248
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	24
Total of all active and inactive participants	2019-01-01	272
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	272
Number of participants with account balances	2019-01-01	149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	1
2018: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	219
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	208
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	20
Total of all active and inactive participants	2018-01-01	228
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	228
Number of participants with account balances	2018-01-01	109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	6
2017: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	119
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	203
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	16
Total of all active and inactive participants	2017-01-01	219
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	219
Number of participants with account balances	2017-01-01	102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	5
2016: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	147
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	173
Number of retired or separated participants receiving benefits	2016-01-01	2
Number of other retired or separated participants entitled to future benefits	2016-01-01	8
Total of all active and inactive participants	2016-01-01	183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	183
Number of participants with account balances	2016-01-01	71
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	1

Financial Data on SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN

Measure	Date	Value
2022 : SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$0
Total income from all sources (including contributions)	2022-12-31	$256,971
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$712,889
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$650,239
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$2,443,488
Value of total assets at end of year	2022-12-31	$12,003,378
Value of total assets at beginning of year	2022-12-31	$12,459,296
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$62,650
Total interest from all sources	2022-12-31	$16,572
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$9,876
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-12-31	$9,876
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$500,000
If this is an individual account plan, was there a blackout period	2022-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$1,467,775
Participant contributions at end of year	2022-12-31	$313,701
Participant contributions at beginning of year	2022-12-31	$278,081
Income. Received or receivable in cash from other sources (including rollovers)	2022-12-31	$125,867
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-12-31	$1,687
Other income not declared elsewhere	2022-12-31	$6
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$-455,918
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$12,003,378
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$12,459,296
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-12-31	$903,028
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-12-31	$1,001,066
Value of interest in pooled separate accounts at end of year	2022-12-31	$358,557
Value of interest in pooled separate accounts at beginning of year	2022-12-31	$431,851
Interest on participant loans	2022-12-31	$14,612
Interest earned on other investments	2022-12-31	$1,960
Value of interest in common/collective trusts at end of year	2022-12-31	$10,337,378
Value of interest in common/collective trusts at beginning of year	2022-12-31	$10,661,819
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-12-31	$90,714
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-12-31	$86,479
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-12-31	$-275,952
Net investment gain/loss from pooled separate accounts	2022-12-31	$-69,147
Net investment gain or loss from common/collective trusts	2022-12-31	$-1,867,872
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	No
Was there a failure to transmit to the plan any participant contributions	2022-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$849,846
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-12-31	$648,552
Contract administrator fees	2022-12-31	$62,650
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	ARMANINO LLP
Accountancy firm EIN	2022-12-31	946214841
2021 : SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$4,166,964
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$288,051
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$232,749
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$2,755,858
Value of total assets at end of year	2021-12-31	$12,459,296
Value of total assets at beginning of year	2021-12-31	$8,580,383
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$55,302
Total interest from all sources	2021-12-31	$13,543
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$9,322
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$9,322
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$1,148,273
Participant contributions at end of year	2021-12-31	$278,081
Participant contributions at beginning of year	2021-12-31	$230,162
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$962,163
Other income not declared elsewhere	2021-12-31	$254
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$3,878,913
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$12,459,296
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$8,580,383
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$1,001,066
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$641,681
Value of interest in pooled separate accounts at end of year	2021-12-31	$431,851
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$256,270
Interest on participant loans	2021-12-31	$11,643
Interest earned on other investments	2021-12-31	$1,900
Value of interest in common/collective trusts at end of year	2021-12-31	$10,661,819
Value of interest in common/collective trusts at beginning of year	2021-12-31	$7,331,837
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$86,479
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$120,433
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$129,288
Net investment gain/loss from pooled separate accounts	2021-12-31	$75,268
Net investment gain or loss from common/collective trusts	2021-12-31	$1,183,431
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$645,422
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$232,749
Contract administrator fees	2021-12-31	$55,302
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	BEELS SOPER LLP
Accountancy firm EIN	2021-12-31	202877111
2020 : SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets	2020-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2020-12-31	$0
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Expenses. Interest paid	2020-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$2,611,275
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$280,586
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$255,121
Expenses. Certain deemed distributions of participant loans	2020-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,678,822
Value of total assets at end of year	2020-12-31	$8,580,383
Value of total assets at beginning of year	2020-12-31	$6,249,694
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$25,465
Total income from rents	2020-12-31	$0
Total interest from all sources	2020-12-31	$14,088
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$6,124
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$6,124
Administrative expenses professional fees incurred	2020-12-31	$0
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$999,481
Participant contributions at end of year	2020-12-31	$230,162
Participant contributions at beginning of year	2020-12-31	$239,991
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$130,444
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2020-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$0
Other income not declared elsewhere	2020-12-31	$0
Administrative expenses (other) incurred	2020-12-31	$0
Liabilities. Value of operating payables at end of year	2020-12-31	$0
Liabilities. Value of operating payables at beginning of year	2020-12-31	$0
Total non interest bearing cash at end of year	2020-12-31	$0
Total non interest bearing cash at beginning of year	2020-12-31	$9,478
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$2,330,689
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$8,580,383
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$6,249,694
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Investment advisory and management fees	2020-12-31	$25,465
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$641,681
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$5,988,517
Value of interest in pooled separate accounts at end of year	2020-12-31	$256,270
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$0
Interest on participant loans	2020-12-31	$14,088
Income. Interest from loans (other than to participants)	2020-12-31	$0
Interest earned on other investments	2020-12-31	$0
Income. Interest from US Government securities	2020-12-31	$0
Income. Interest from corporate debt instruments	2020-12-31	$0
Value of interest in common/collective trusts at end of year	2020-12-31	$7,331,837
Value of interest in common/collective trusts at beginning of year	2020-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$120,433
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$0
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$912,241
Net gain/loss from 103.12 investment entities	2020-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$548,897
Employer contributions (assets) at end of year	2020-12-31	$0
Employer contributions (assets) at beginning of year	2020-12-31	$11,708
Income. Dividends from preferred stock	2020-12-31	$0
Income. Dividends from common stock	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$255,121
Contract administrator fees	2020-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-12-31	Yes
Liabilities. Value of benefit claims payable at end of year	2020-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2020-12-31	$0
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Aggregate proceeds on sale of assets	2020-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2020-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2020-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2020-12-31	$0
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	BEELS SOPER LLP
Accountancy firm EIN	2020-12-31	202877111
2019 : SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$2,094,884
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$161,393
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$158,442
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,102,912
Value of total assets at end of year	2019-12-31	$6,249,694
Value of total assets at beginning of year	2019-12-31	$4,316,203
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$2,951
Total interest from all sources	2019-12-31	$11,217
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$696,432
Participant contributions at end of year	2019-12-31	$239,991
Participant contributions at beginning of year	2019-12-31	$161,453
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$5,493
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$47,791
Total non interest bearing cash at end of year	2019-12-31	$9,478
Total non interest bearing cash at beginning of year	2019-12-31	$8,925
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$1,933,491
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$6,249,694
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,316,203
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$5,988,517
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$4,098,119
Interest on participant loans	2019-12-31	$11,217
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$980,755
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$358,689
Employer contributions (assets) at end of year	2019-12-31	$11,708
Employer contributions (assets) at beginning of year	2019-12-31	$42,213
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$158,442
Contract administrator fees	2019-12-31	$2,951
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	CALVIN MARTIN & CO, PLLC
Accountancy firm EIN	2019-12-31	760591623
2018 : SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2018 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total income from all sources (including contributions)	2017-12-31	$1,210,508
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$118,328
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$116,318
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$706,181
Value of total assets at end of year	2017-12-31	$4,130,849
Value of total assets at beginning of year	2017-12-31	$3,038,669
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$2,010
Total interest from all sources	2017-12-31	$4,339
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Administrative expenses professional fees incurred	2017-12-31	$2,010
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$450,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$468,968
Participant contributions at end of year	2017-12-31	$138,044
Participant contributions at beginning of year	2017-12-31	$50,648
Participant contributions at end of year	2017-12-31	$0
Participant contributions at beginning of year	2017-12-31	$264
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$1,596
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$3,635
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$2,039
Total non interest bearing cash at end of year	2017-12-31	$2,675
Total non interest bearing cash at beginning of year	2017-12-31	$1,038
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$1,092,180
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$4,130,849
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$3,038,669
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$3,990,130
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$2,986,531
Interest on participant loans	2017-12-31	$4,339
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$499,988
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$237,213
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$188
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$116,318
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	CLIENT HAS NOT PROVIDED
Accountancy firm EIN	2017-12-31	760591623
2016 : SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$774,251
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$216,269
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$214,603
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$546,939
Value of total assets at end of year	2016-12-31	$3,063,910
Value of total assets at beginning of year	2016-12-31	$2,505,928
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$1,666
Total interest from all sources	2016-12-31	$2,410
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$1,666
Was this plan covered by a fidelity bond	2016-12-31	No
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$351,973
Participant contributions at end of year	2016-12-31	$50,648
Participant contributions at beginning of year	2016-12-31	$56,659
Participant contributions at end of year	2016-12-31	$264
Participant contributions at beginning of year	2016-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$2,039
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$2,039
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$0
Total non interest bearing cash at end of year	2016-12-31	$1,038
Total non interest bearing cash at beginning of year	2016-12-31	$1,138
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$557,982
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$3,063,910
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,505,928
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in pooled separate accounts at end of year	2016-12-31	$2,986,531
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$2,448,131
Interest on participant loans	2016-12-31	$2,410
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$224,902
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$192,927
Employer contributions (assets) at end of year	2016-12-31	$23,390
Employer contributions (assets) at beginning of year	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$214,603
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2016-12-31	No
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	CALVIN MARTIN & COMPANY, PLLC
Accountancy firm EIN	2016-12-31	760591623

Form 5500 Responses for SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN

2022: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
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 – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	Yes
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 – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: SIDDONS MARTIN EMERGENCY GROUP 401(K) 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 – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: SIDDONS MARTIN EMERGENCY GROUP 401(K) 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 – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: SIDDONS MARTIN EMERGENCY GROUP 401(K) 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 – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: SIDDONS MARTIN EMERGENCY GROUP 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	Yes
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 - Trust	Yes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	502
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

470407

Policy instance

Insurance contract or identification number	470407
Number of Individuals Covered	502
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	348
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $15
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	15
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

470407

Policy instance

Insurance contract or identification number	470407
Number of Individuals Covered	348
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $32
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	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 $0
Amount paid for insurance broker fees	32
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

613953

Policy instance

Insurance contract or identification number	613953
Number of Individuals Covered	295
Insurance policy start date	2020-05-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $17
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 $0
Amount paid for insurance broker fees	17
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )

Policy contract number

470407

Policy instance

Insurance contract or identification number	470407
Number of Individuals Covered	295
Insurance policy start date	2020-05-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $24
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	24
Additional information about fees paid to insurance broker	REFERRAL/SERVICE FEE
Insurance broker organization code?	3

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

Policy contract number

110427

Policy instance

Insurance contract or identification number	110427
Number of Individuals Covered	152
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $4,533
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	Yes
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 $4,533
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	TPA
Insurance broker organization code?	5

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

Policy contract number

110427

Policy instance

Insurance contract or identification number	110427
Number of Individuals Covered	116
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,359
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	Yes
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 $3,359
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	TPA
Insurance broker organization code?	5

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

Policy contract number

110427

Policy instance

Insurance contract or identification number	110427
Number of Individuals Covered	104
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $5,919
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	Yes
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 $3,663
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	TPA
Insurance broker organization code?	5
Insurance broker name	EDWARD D. JONES & CO., L.P.

Potentially related plans

SIDDONS MARTIN EMPLOYEE STOCK OWNERSHIP PLAN [EIN = 844074651]

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Company Name:	SIDDONS-MARTIN EMERGENCY GROUP, LLC
Employer identification number (EIN):	274333590
NAIC Classification:	621900