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MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 401k Plan overview

Plan NameMERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN
Plan identification number 001

MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN Benefits

401k Plan TypeDefined 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

MERCY ANESTHESIOLOGISTS, INC. has sponsored the creation of one or more 401k plans.

Company Name:MERCY ANESTHESIOLOGISTS, INC.
Employer identification number (EIN):310791535
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Additional information about MERCY ANESTHESIOLOGISTS, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1970-06-26
Company Identification Number: 399171
Legal Registered Office Address: 2790 KILKENNY DR.
-
SPRINGFIELD
United States of America (USA)
45503

More information about MERCY ANESTHESIOLOGISTS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01THALES N. PAVLATOS2023-09-29
0012021-01-01THALES N. PAVLATOS2022-06-10
0012020-01-01THALES N. PAVLATOS2021-09-28
0012019-01-01THALES N. PAVLATOS2020-09-03
0012018-01-01THALES N. PAVLATOS2019-10-02
0012017-01-01THALES N. PAVLATOS
0012016-01-01THALES N. PAVLATOS
0012015-01-01THALES N. PAVLATOS
0012014-01-01THALES N. PAVLATOS
0012013-01-01THALES N. PAVLATOS
0012012-01-01THALES N. PAVLATOS
0012011-01-01THALES N. PAVLATOS
0012010-01-01THALES N. PAVLATOS
0012009-01-01THALES N. PAVLATOS

Plan Statistics for MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN

Measure Date Value
2017: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0120
Total number of active participants reported on line 7a of the Form 55002017-01-0112
Number of retired or separated participants receiving benefits2017-01-012
Number of other retired or separated participants entitled to future benefits2017-01-016
Total of all active and inactive participants2017-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0120
Number of participants with account balances2017-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0123
Total number of active participants reported on line 7a of the Form 55002016-01-0113
Number of retired or separated participants receiving benefits2016-01-012
Number of other retired or separated participants entitled to future benefits2016-01-015
Total of all active and inactive participants2016-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0120
Number of participants with account balances2016-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0124
Total number of active participants reported on line 7a of the Form 55002015-01-0113
Number of retired or separated participants receiving benefits2015-01-013
Number of other retired or separated participants entitled to future benefits2015-01-017
Total of all active and inactive participants2015-01-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0123
Number of participants with account balances2015-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0124
Total number of active participants reported on line 7a of the Form 55002014-01-0113
Number of retired or separated participants receiving benefits2014-01-013
Number of other retired or separated participants entitled to future benefits2014-01-018
Total of all active and inactive participants2014-01-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0124
Number of participants with account balances2014-01-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0123
Total number of active participants reported on line 7a of the Form 55002013-01-0112
Number of retired or separated participants receiving benefits2013-01-013
Number of other retired or separated participants entitled to future benefits2013-01-018
Total of all active and inactive participants2013-01-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0123
Number of participants with account balances2013-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0122
Total number of active participants reported on line 7a of the Form 55002012-01-0111
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0112
Total of all active and inactive participants2012-01-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0123
Number of participants with account balances2012-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0123
Total number of active participants reported on line 7a of the Form 55002011-01-0112
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0110
Total of all active and inactive participants2011-01-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0122
Number of participants with account balances2011-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-0122
2010: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0117
Total number of active participants reported on line 7a of the Form 55002010-01-0113
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0110
Total of all active and inactive participants2010-01-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0123
Number of participants with account balances2010-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0110
Total number of active participants reported on line 7a of the Form 55002009-01-0112
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-011
Total of all active and inactive participants2009-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0113
Number of participants with account balances2009-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-011

Financial Data on MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN

Measure Date Value
2017 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources2017-12-31$3,177,669
Expenses. Total of all expenses incurred2017-12-31$196,300
Benefits paid (including direct rollovers)2017-12-31$161,882
Total plan assets at end of year2017-12-31$15,565,028
Total plan assets at beginning of year2017-12-31$12,583,659
Value of fidelity bond covering the plan2017-12-31$650,000
Total contributions received or receivable from participants2017-12-31$169,430
Other income received2017-12-31$2,798,513
Net income (gross income less expenses)2017-12-31$2,981,369
Net plan assets at end of year (total assets less liabilities)2017-12-31$15,565,028
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$12,583,659
Assets. Value of real-estate (other than employer real property)2017-12-31$0
Total contributions received or receivable from employer(s)2017-12-31$209,726
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$34,418
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-12-31$1,240,112
Expenses. Total of all expenses incurred2016-12-31$84,552
Benefits paid (including direct rollovers)2016-12-31$51,345
Total plan assets at end of year2016-12-31$12,583,659
Total plan assets at beginning of year2016-12-31$11,428,099
Value of fidelity bond covering the plan2016-12-31$650,000
Total contributions received or receivable from participants2016-12-31$145,316
Other income received2016-12-31$888,977
Net income (gross income less expenses)2016-12-31$1,155,560
Net plan assets at end of year (total assets less liabilities)2016-12-31$12,583,659
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$11,428,099
Assets. Value of real-estate (other than employer real property)2016-12-31$636,588
Total contributions received or receivable from employer(s)2016-12-31$205,819
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$33,207
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$214,891
Expenses. Total of all expenses incurred2015-12-31$40,949
Benefits paid (including direct rollovers)2015-12-31$7,719
Total plan assets at end of year2015-12-31$11,428,099
Total plan assets at beginning of year2015-12-31$11,254,157
Value of fidelity bond covering the plan2015-12-31$650,000
Total contributions received or receivable from participants2015-12-31$149,931
Contributions received from other sources (not participants or employers)2015-12-31$10,093
Other income received2015-12-31$-158,644
Net income (gross income less expenses)2015-12-31$173,942
Net plan assets at end of year (total assets less liabilities)2015-12-31$11,428,099
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$11,254,157
Assets. Value of real-estate (other than employer real property)2015-12-31$636,588
Total contributions received or receivable from employer(s)2015-12-31$213,511
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$33,230
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-12-31$1,043,701
Expenses. Total of all expenses incurred2014-12-31$25,395
Total plan assets at end of year2014-12-31$11,254,157
Total plan assets at beginning of year2014-12-31$10,235,851
Value of fidelity bond covering the plan2014-12-31$650,000
Total contributions received or receivable from participants2014-12-31$149,278
Other income received2014-12-31$678,740
Net income (gross income less expenses)2014-12-31$1,018,306
Net plan assets at end of year (total assets less liabilities)2014-12-31$11,254,157
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$10,235,851
Assets. Value of real-estate (other than employer real property)2014-12-31$636,588
Total contributions received or receivable from employer(s)2014-12-31$215,683
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$25,395
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-12-31$1,863,781
Expenses. Total of all expenses incurred2013-12-31$278,513
Benefits paid (including direct rollovers)2013-12-31$253,757
Total plan assets at end of year2013-12-31$10,235,851
Total plan assets at beginning of year2013-12-31$8,650,583
Value of fidelity bond covering the plan2013-12-31$650,000
Total contributions received or receivable from participants2013-12-31$140,315
Contributions received from other sources (not participants or employers)2013-12-31$42,722
Other income received2013-12-31$1,437,126
Net income (gross income less expenses)2013-12-31$1,585,268
Net plan assets at end of year (total assets less liabilities)2013-12-31$10,235,851
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$8,650,583
Assets. Value of real-estate (other than employer real property)2013-12-31$636,588
Total contributions received or receivable from employer(s)2013-12-31$243,618
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$24,756
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-12-31$1,249,839
Expenses. Total of all expenses incurred2012-12-31$55,143
Benefits paid (including direct rollovers)2012-12-31$36,632
Total plan assets at end of year2012-12-31$8,650,583
Total plan assets at beginning of year2012-12-31$7,455,887
Value of fidelity bond covering the plan2012-12-31$650,000
Total contributions received or receivable from participants2012-12-31$117,016
Other income received2012-12-31$904,439
Net income (gross income less expenses)2012-12-31$1,194,696
Net plan assets at end of year (total assets less liabilities)2012-12-31$8,650,583
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$7,455,887
Assets. Value of real-estate (other than employer real property)2012-12-31$636,588
Total contributions received or receivable from employer(s)2012-12-31$228,384
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$18,511
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$135,471
Expenses. Total of all expenses incurred2011-12-31$42,694
Benefits paid (including direct rollovers)2011-12-31$23,761
Total plan assets at end of year2011-12-31$7,455,887
Total plan assets at beginning of year2011-12-31$7,363,110
Value of fidelity bond covering the plan2011-12-31$650,000
Total contributions received or receivable from participants2011-12-31$116,340
Other income received2011-12-31$-200,794
Net income (gross income less expenses)2011-12-31$92,777
Net plan assets at end of year (total assets less liabilities)2011-12-31$7,455,887
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$7,363,110
Assets. Value of real-estate (other than employer real property)2011-12-31$636,588
Total contributions received or receivable from employer(s)2011-12-31$219,925
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$18,933
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2010 401k financial data
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$1,263,833
Expenses. Total of all expenses incurred2010-12-31$18,370
Total plan assets at end of year2010-12-31$7,363,110
Total plan assets at beginning of year2010-12-31$6,117,647
Value of fidelity bond covering the plan2010-12-31$650,000
Total contributions received or receivable from participants2010-12-31$166,098
Other income received2010-12-31$839,355
Net income (gross income less expenses)2010-12-31$1,245,463
Net plan assets at end of year (total assets less liabilities)2010-12-31$7,363,110
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$6,117,647
Assets. Value of real-estate (other than employer real property)2010-12-31$636,588
Total contributions received or receivable from employer(s)2010-12-31$258,380
Value of certain deemed distributions of participant loans2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$18,370
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN

2017: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: MERCY ANESTHESIOLOGISTS, INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE1531079
Policy instance 2
Insurance contract or identification numberE1531079
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,303
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $2,303
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL, JANET STROUD
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE1343089
Policy instance 1
Insurance contract or identification numberE1343089
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,014
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $784
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL CORPORATION
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE1531079
Policy instance 2
Insurance contract or identification numberE1531079
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,987
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $1,987
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL, JANET STROUD
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE1343089
Policy instance 1
Insurance contract or identification numberE1343089
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $225
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $225
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL CORPORATION
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE1531079
Policy instance 2
Insurance contract or identification numberE1531079
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,770
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $1,385
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL, JANET STROUD
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE1343089
Policy instance 1
Insurance contract or identification numberE1343089
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $442
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $221
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL, STEVEN STROUD
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE1531079
Policy instance 2
Insurance contract or identification numberE1531079
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $6,802
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $3,401
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL, JANET STROUD
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE1343089
Policy instance 1
Insurance contract or identification numberE1343089
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $402
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $201
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL, JANET STROUD
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE1343089
Policy instance 1
Insurance contract or identification numberE1343089
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $172
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $0
Amount paid for insurance broker fees172
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL CORPORATION
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 79065 )
Policy contract number1050005456
Policy instance 1
Insurance contract or identification number1050005456
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,008
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 79065 )
Policy contract number1050005456
Policy instance 1
Insurance contract or identification number1050005456
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,008
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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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