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AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN 401k Plan overview

Plan NameAMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN
Plan identification number 003

AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

AMERICAN MEDICAL TECHNOLOGY, INC. has sponsored the creation of one or more 401k plans.

Company Name:AMERICAN MEDICAL TECHNOLOGY, INC.
Employer identification number (EIN):341585439
NAIC Classification:621610
NAIC Description:Home Health Care Services

Additional information about AMERICAN MEDICAL TECHNOLOGY, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1996-03-01
Company Identification Number: P96000019968
Legal Registered Office Address: 4328 SW 73RD AVE

MIAMI

33155

More information about AMERICAN MEDICAL TECHNOLOGY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032017-01-01GEORGE PICHA
0032016-01-01GEORGE PICHA
0032015-01-01GEORGE PICHA2016-10-14
0032014-01-01GEORGE PICHA2015-10-12
0032013-01-01GEORGE PICHA2014-10-10
0032012-01-01GEORGE PICHA2013-10-10
0032011-01-01GEORGE PICHA GEORGE PICHA2012-10-16
0032010-01-01GEORGE PICHA2011-10-12 GEORGE PICHA2011-10-12

Plan Statistics for AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN

Measure Date Value
2017: AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01174
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-010
Number of participants with account balances2017-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01165
Total number of active participants reported on line 7a of the Form 55002016-01-0190
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0184
Total of all active and inactive participants2016-01-01174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01174
Number of participants with account balances2016-01-01174
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-0139
2011: AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01131
Total number of active participants reported on line 7a of the Form 55002011-01-0167
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-013
Total of all active and inactive participants2011-01-0170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0170
Number of participants with account balances2011-01-0170
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-0117

Financial Data on AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN

Measure Date Value
2017 : AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-26$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-26$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-26$0
Total income from all sources (including contributions)2017-12-26$230,435
Total loss/gain on sale of assets2017-12-26$0
Total of all expenses incurred2017-12-26$1,417,245
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-26$1,370,991
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-26$83,246
Value of total assets at end of year2017-12-26$0
Value of total assets at beginning of year2017-12-26$1,186,810
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-26$46,254
Total interest from all sources2017-12-26$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-26$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-26Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2017-12-26$0
Administrative expenses professional fees incurred2017-12-26$12,000
Was this plan covered by a fidelity bond2017-12-26Yes
Value of fidelity bond cover2017-12-26$500,000
If this is an individual account plan, was there a blackout period2017-12-26No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-26$0
Were there any nonexempt tranactions with any party-in-interest2017-12-26No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-26No
Value of net income/loss2017-12-26$-1,186,810
Value of net assets at end of year (total assets less liabilities)2017-12-26$0
Value of net assets at beginning of year (total assets less liabilities)2017-12-26$1,186,810
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-26No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-26No
Were any leases to which the plan was party in default or uncollectible2017-12-26No
Value of interest in pooled separate accounts at end of year2017-12-26$0
Value of interest in pooled separate accounts at beginning of year2017-12-26$996,312
Net investment gain/loss from pooled separate accounts2017-12-26$147,189
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-26No
Was there a failure to transmit to the plan any participant contributions2017-12-26No
Has the plan failed to provide any benefit when due under the plan2017-12-26No
Contributions received in cash from employer2017-12-26$83,246
Employer contributions (assets) at end of year2017-12-26$0
Employer contributions (assets) at beginning of year2017-12-26$190,498
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-26$1,370,991
Contract administrator fees2017-12-26$34,254
Did the plan have assets held for investment2017-12-26No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-26No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-26Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-26Yes
Opinion of an independent qualified public accountant for this plan2017-12-26Disclaimer
Accountancy firm name2017-12-26MALONEY & NOVOTNY, LLC
Accountancy firm EIN2017-12-26340677006
2016 : AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$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$226,101
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$50,080
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$48,635
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$190,498
Value of total assets at end of year2016-12-31$1,186,810
Value of total assets at beginning of year2016-12-31$1,010,789
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$1,445
Total interest from all sources2016-12-31$0
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 year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$176,021
Value of net assets at end of year (total assets less liabilities)2016-12-31$1,186,810
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$1,010,789
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in pooled separate accounts at end of year2016-12-31$996,312
Value of interest in pooled separate accounts at beginning of year2016-12-31$833,809
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$35,603
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$190,498
Employer contributions (assets) at end of year2016-12-31$190,498
Employer contributions (assets) at beginning of year2016-12-31$176,980
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$48,635
Contract administrator fees2016-12-31$1,445
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31MALONEY & NOVOTNY, LLC
Accountancy firm EIN2016-12-31340677006
2011 : AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN 2011 401k financial data
Unrealized appreciation/depreciation of real estate assets2011-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$0
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total transfer of assets to this plan2011-12-31$0
Total transfer of assets from this plan2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Expenses. Interest paid2011-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022011-12-31$0
Total income from all sources (including contributions)2011-12-31$132,052
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$0
Expenses. Certain deemed distributions of participant loans2011-12-31$0
Value of total corrective distributions2011-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$132,288
Value of total assets at end of year2011-12-31$403,354
Value of total assets at beginning of year2011-12-31$271,302
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$0
Total income from rents2011-12-31$0
Total interest from all sources2011-12-31$-89
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$-147
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Assets. Real estate other than employer real property at end of year2011-12-31$0
Assets. Real estate other than employer real property at beginning of year2011-12-31$0
Administrative expenses professional fees incurred2011-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2011-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2011-12-31$0
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$100,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$0
Participant contributions at end of year2011-12-31$0
Participant contributions at beginning of year2011-12-31$0
Participant contributions at end of year2011-12-31$0
Participant contributions at beginning of year2011-12-31$0
Assets. Other investments not covered elsewhere at end of year2011-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$0
Assets. Loans (other than to participants) at end of year2011-12-31$0
Assets. Loans (other than to participants) at beginning of year2011-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$0
Other income not declared elsewhere2011-12-31$0
Administrative expenses (other) incurred2011-12-31$0
Liabilities. Value of operating payables at end of year2011-12-31$0
Liabilities. Value of operating payables at beginning of year2011-12-31$0
Total non interest bearing cash at end of year2011-12-31$0
Total non interest bearing cash at beginning of year2011-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Income. Non cash contributions2011-12-31$0
Value of net income/loss2011-12-31$132,052
Value of net assets at end of year (total assets less liabilities)2011-12-31$403,354
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$271,302
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Assets. partnership/joint venture interests at end of year2011-12-31$0
Assets. partnership/joint venture interests at beginning of year2011-12-31$0
Investment advisory and management fees2011-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$259,740
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$147,150
Value of interest in pooled separate accounts at end of year2011-12-31$0
Value of interest in pooled separate accounts at beginning of year2011-12-31$0
Interest on participant loans2011-12-31$0
Income. Interest from loans (other than to participants)2011-12-31$0
Interest earned on other investments2011-12-31$0
Income. Interest from US Government securities2011-12-31$-10
Income. Interest from corporate debt instruments2011-12-31$0
Value of interest in master investment trust accounts at end of year2011-12-31$0
Value of interest in master investment trust accounts at beginning of year2011-12-31$0
Value of interest in common/collective trusts at end of year2011-12-31$0
Value of interest in common/collective trusts at beginning of year2011-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$11,326
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$8,220
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$8,220
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$-79
Assets. Value of investments in 103.12 investment entities at end of year2011-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2011-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$0
Asset value of US Government securities at end of year2011-12-31$0
Asset value of US Government securities at beginning of year2011-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$0
Net investment gain/loss from pooled separate accounts2011-12-31$0
Net investment gain or loss from common/collective trusts2011-12-31$0
Net gain/loss from 103.12 investment entities2011-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Assets. Invements in employer securities at end of year2011-12-31$0
Assets. Invements in employer securities at beginning of year2011-12-31$0
Assets. Value of employer real property at end of year2011-12-31$0
Assets. Value of employer real property at beginning of year2011-12-31$0
Contributions received in cash from employer2011-12-31$132,288
Employer contributions (assets) at end of year2011-12-31$132,288
Employer contributions (assets) at beginning of year2011-12-31$115,932
Income. Dividends from preferred stock2011-12-31$0
Income. Dividends from common stock2011-12-31$-147
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$0
Asset. Corporate debt instrument preferred debt at end of year2011-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2011-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2011-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2011-12-31$0
Contract administrator fees2011-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2011-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2011-12-31$0
Liabilities. Value of benefit claims payable at end of year2011-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2011-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2011-12-31$0
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Aggregate proceeds on sale of assets2011-12-31$0
Aggregate carrying amount (costs) on sale of assets2011-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2011-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2011-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31MALONEY NOVOTNY, LLC
Accountancy firm EIN2011-12-31340677006

Form 5500 Responses for AMERICAN MEDICAL TECHNOLOGY, INC. PROFIT SHARING PLAN

2017: AMERICAN MEDICAL TECHNOLOGY, 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 filingYes
2017-01-01This return/report is a short plan year return/report (less than 12 months)Yes
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: AMERICAN MEDICAL TECHNOLOGY, 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
2011: AMERICAN MEDICAL TECHNOLOGY, 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 - TrustYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-823624
Policy instance 1
Insurance contract or identification numberGA-823624
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-26
Total amount of commissions paid to insurance brokerUSD $5,070
Total amount of fees paid to insurance companyUSD $650
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 $2,535
Insurance broker organization code?3
Amount paid for insurance broker fees650
Additional information about fees paid to insurance brokerADMINISTRATIVE ALLOWANCE
Insurance broker nameCBIZ RETIREMENT PLAN SERVICES
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number823624
Policy instance 1
Insurance contract or identification number823624
Number of Individuals Covered61
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $733
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

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