401k Plan data: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN plan

RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN
Plan identification number	001

RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
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.

401k Sponsoring company profile

RETINA VITREOUS CENTER, P.C. has sponsored the creation of one or more 401k plans.

Company Name: RETINA VITREOUS CENTER, P.C.

Employer identification number (EIN): 383093939

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-10-01
001 2014-10-01
001 2013-10-01
001 2012-10-01 ROBIN D. ROSS ROBIN D. ROSS 2015-10-28
001 2011-10-01 ROBIN D. ROSS ROBIN D. ROSS 2015-10-28
001 2010-10-01 ROBIN D. ROSS ROBIN D. ROSS 2012-07-13
001 2009-10-01 ROBIN ROSS ROBIN ROSS 2011-06-14
001 2008-10-01

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2015-10-01
001	2014-10-01
001	2013-10-01
001	2012-10-01	ROBIN D. ROSS	ROBIN D. ROSS	2015-10-28
001	2011-10-01	ROBIN D. ROSS	ROBIN D. ROSS	2015-10-28
001	2010-10-01	ROBIN D. ROSS	ROBIN D. ROSS	2012-07-13
001	2009-10-01	ROBIN ROSS	ROBIN ROSS	2011-06-14
001	2008-10-01

Plan Statistics for RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN

Measure Date Value
2015: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-10-01 17
Total number of active participants reported on line 7a of the Form 5500 2015-10-01 0
Number of retired or separated participants receiving benefits 2015-10-01 0
Number of other retired or separated participants entitled to future benefits 2015-10-01 0
Total of all active and inactive participants 2015-10-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-10-01 0
Total participants 2015-10-01 0
Number of participants with account balances 2015-10-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-10-01 0
2014: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-10-01 19
Total number of active participants reported on line 7a of the Form 5500 2014-10-01 0
Number of retired or separated participants receiving benefits 2014-10-01 0
Number of other retired or separated participants entitled to future benefits 2014-10-01 17
Total of all active and inactive participants 2014-10-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-10-01 0
Total participants 2014-10-01 17
Number of participants with account balances 2014-10-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-10-01 0
2013: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-10-01 18
Total number of active participants reported on line 7a of the Form 5500 2013-10-01 15
Number of retired or separated participants receiving benefits 2013-10-01 0
Number of other retired or separated participants entitled to future benefits 2013-10-01 3
Total of all active and inactive participants 2013-10-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-10-01 0
Total participants 2013-10-01 18
Number of participants with account balances 2013-10-01 18
2012: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-10-01 18
Total number of active participants reported on line 7a of the Form 5500 2012-10-01 15
Number of other retired or separated participants entitled to future benefits 2012-10-01 2
Total of all active and inactive participants 2012-10-01 17
Total participants 2012-10-01 17
Number of participants with account balances 2012-10-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-10-01 0
2011: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-10-01 19
Total number of active participants reported on line 7a of the Form 5500 2011-10-01 14
Number of other retired or separated participants entitled to future benefits 2011-10-01 3
Total of all active and inactive participants 2011-10-01 17
Total participants 2011-10-01 17
Number of participants with account balances 2011-10-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-10-01 1
2010: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-10-01 14
Total number of active participants reported on line 7a of the Form 5500 2010-10-01 10
Number of other retired or separated participants entitled to future benefits 2010-10-01 3
Total of all active and inactive participants 2010-10-01 13
Total participants 2010-10-01 13
Number of participants with account balances 2010-10-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-10-01 1
2009: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-10-01 12
Total number of active participants reported on line 7a of the Form 5500 2009-10-01 10
Number of other retired or separated participants entitled to future benefits 2009-10-01 2
Total of all active and inactive participants 2009-10-01 12
Total participants 2009-10-01 12
Number of participants with account balances 2009-10-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-10-01 0

Measure	Date	Value
2015: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-10-01	17
Total number of active participants reported on line 7a of the Form 5500	2015-10-01	0
Number of retired or separated participants receiving benefits	2015-10-01	0
Number of other retired or separated participants entitled to future benefits	2015-10-01	0
Total of all active and inactive participants	2015-10-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-10-01	0
Total participants	2015-10-01	0
Number of participants with account balances	2015-10-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-10-01	0
2014: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-10-01	19
Total number of active participants reported on line 7a of the Form 5500	2014-10-01	0
Number of retired or separated participants receiving benefits	2014-10-01	0
Number of other retired or separated participants entitled to future benefits	2014-10-01	17
Total of all active and inactive participants	2014-10-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-10-01	0
Total participants	2014-10-01	17
Number of participants with account balances	2014-10-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-10-01	0
2013: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-10-01	18
Total number of active participants reported on line 7a of the Form 5500	2013-10-01	15
Number of retired or separated participants receiving benefits	2013-10-01	0
Number of other retired or separated participants entitled to future benefits	2013-10-01	3
Total of all active and inactive participants	2013-10-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-10-01	0
Total participants	2013-10-01	18
Number of participants with account balances	2013-10-01	18
2012: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-10-01	18
Total number of active participants reported on line 7a of the Form 5500	2012-10-01	15
Number of other retired or separated participants entitled to future benefits	2012-10-01	2
Total of all active and inactive participants	2012-10-01	17
Total participants	2012-10-01	17
Number of participants with account balances	2012-10-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-10-01	0
2011: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-10-01	19
Total number of active participants reported on line 7a of the Form 5500	2011-10-01	14
Number of other retired or separated participants entitled to future benefits	2011-10-01	3
Total of all active and inactive participants	2011-10-01	17
Total participants	2011-10-01	17
Number of participants with account balances	2011-10-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-10-01	1
2010: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-10-01	14
Total number of active participants reported on line 7a of the Form 5500	2010-10-01	10
Number of other retired or separated participants entitled to future benefits	2010-10-01	3
Total of all active and inactive participants	2010-10-01	13
Total participants	2010-10-01	13
Number of participants with account balances	2010-10-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-10-01	1
2009: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-10-01	12
Total number of active participants reported on line 7a of the Form 5500	2009-10-01	10
Number of other retired or separated participants entitled to future benefits	2009-10-01	2
Total of all active and inactive participants	2009-10-01	12
Total participants	2009-10-01	12
Number of participants with account balances	2009-10-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-10-01	0

Financial Data on RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2015 : RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources	2015-11-30	$1,251
Expenses. Total of all expenses incurred	2015-11-30	$366,524
Benefits paid (including direct rollovers)	2015-11-30	$364,263
Total plan assets at end of year	2015-11-30	$0
Total plan assets at beginning of year	2015-11-30	$365,273
Value of fidelity bond covering the plan	2015-11-30	$450,000
Other income received	2015-11-30	$1,251
Net income (gross income less expenses)	2015-11-30	$-365,273
Net plan assets at end of year (total assets less liabilities)	2015-11-30	$0
Net plan assets at beginning of year (total assets less liabilities)	2015-11-30	$365,273
Expenses. Administrative service providers (salaries,fees and commissions)	2015-11-30	$2,261
Total income from all sources	2015-09-30	$15,311
Expenses. Total of all expenses incurred	2015-09-30	$65,961
Benefits paid (including direct rollovers)	2015-09-30	$60,434
Total plan assets at end of year	2015-09-30	$365,273
Total plan assets at beginning of year	2015-09-30	$415,923
Value of fidelity bond covering the plan	2015-09-30	$450,000
Total contributions received or receivable from participants	2015-09-30	$6,275
Other income received	2015-09-30	$4,092
Net income (gross income less expenses)	2015-09-30	$-50,650
Net plan assets at end of year (total assets less liabilities)	2015-09-30	$365,273
Net plan assets at beginning of year (total assets less liabilities)	2015-09-30	$415,923
Total contributions received or receivable from employer(s)	2015-09-30	$4,944
Expenses. Administrative service providers (salaries,fees and commissions)	2015-09-30	$5,527
2014 : RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-09-30	$23,598
Expenses. Total of all expenses incurred	2014-09-30	$4,787
Benefits paid (including direct rollovers)	2014-09-30	$3,271
Total plan assets at end of year	2014-09-30	$495,853
Total plan assets at beginning of year	2014-09-30	$477,042
Value of fidelity bond covering the plan	2014-09-30	$450,000
Total contributions received or receivable from participants	2014-09-30	$27,481
Contributions received from other sources (not participants or employers)	2014-09-30	$3,369
Other income received	2014-09-30	$-29,101
Net income (gross income less expenses)	2014-09-30	$18,811
Net plan assets at end of year (total assets less liabilities)	2014-09-30	$495,853
Net plan assets at beginning of year (total assets less liabilities)	2014-09-30	$477,042
Total contributions received or receivable from employer(s)	2014-09-30	$21,849
Expenses. Administrative service providers (salaries,fees and commissions)	2014-09-30	$1,516
2013 : RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-09-30	$35,052
Expenses. Total of all expenses incurred	2013-09-30	$27,596
Benefits paid (including direct rollovers)	2013-09-30	$26,345
Total plan assets at end of year	2013-09-30	$477,042
Total plan assets at beginning of year	2013-09-30	$469,586
Value of fidelity bond covering the plan	2013-09-30	$450,000
Total contributions received or receivable from participants	2013-09-30	$31,861
Other income received	2013-09-30	$-113,324
Net income (gross income less expenses)	2013-09-30	$7,456
Net plan assets at end of year (total assets less liabilities)	2013-09-30	$477,042
Net plan assets at beginning of year (total assets less liabilities)	2013-09-30	$469,586
Total contributions received or receivable from employer(s)	2013-09-30	$116,515
Expenses. Administrative service providers (salaries,fees and commissions)	2013-09-30	$1,251
2012 : RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-09-30	$146,910
Expenses. Total of all expenses incurred	2012-09-30	$3,586
Benefits paid (including direct rollovers)	2012-09-30	$1,268
Total plan assets at end of year	2012-09-30	$469,586
Total plan assets at beginning of year	2012-09-30	$326,262
Value of fidelity bond covering the plan	2012-09-30	$350,000
Total contributions received or receivable from participants	2012-09-30	$33,563
Other income received	2012-09-30	$-3,813
Net income (gross income less expenses)	2012-09-30	$143,324
Net plan assets at end of year (total assets less liabilities)	2012-09-30	$469,586
Net plan assets at beginning of year (total assets less liabilities)	2012-09-30	$326,262
Total contributions received or receivable from employer(s)	2012-09-30	$117,160
Expenses. Administrative service providers (salaries,fees and commissions)	2012-09-30	$2,318
2011 : RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-09-30	$81,333
Expenses. Total of all expenses incurred	2011-09-30	$26,111
Benefits paid (including direct rollovers)	2011-09-30	$22,449
Total plan assets at end of year	2011-09-30	$326,262
Total plan assets at beginning of year	2011-09-30	$271,040
Value of fidelity bond covering the plan	2011-09-30	$350,000
Total contributions received or receivable from participants	2011-09-30	$19,844
Other income received	2011-09-30	$-42,355
Net income (gross income less expenses)	2011-09-30	$55,222
Net plan assets at end of year (total assets less liabilities)	2011-09-30	$326,262
Net plan assets at beginning of year (total assets less liabilities)	2011-09-30	$271,040
Total contributions received or receivable from employer(s)	2011-09-30	$103,844
Expenses. Administrative service providers (salaries,fees and commissions)	2011-09-30	$3,662

Form 5500 Responses for RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN

2015: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-10-01	Type of plan entity	Single employer plan
2015-10-01	Submission has been amended	No
2015-10-01	This submission is the final filing	Yes
2015-10-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-10-01	Plan is a collectively bargained plan	No
2015-10-01	Plan funding arrangement – Insurance	Yes
2015-10-01	Plan funding arrangement – Trust	Yes
2015-10-01	Plan benefit arrangement - Trust	Yes
2014: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-10-01	Type of plan entity	Single employer plan
2014-10-01	Submission has been amended	No
2014-10-01	This submission is the final filing	No
2014-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-10-01	Plan is a collectively bargained plan	No
2014-10-01	Plan funding arrangement – Insurance	Yes
2014-10-01	Plan funding arrangement – Trust	Yes
2014-10-01	Plan benefit arrangement - Trust	Yes
2013: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-10-01	Type of plan entity	Single employer plan
2013-10-01	Submission has been amended	Yes
2013-10-01	This submission is the final filing	No
2013-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-10-01	Plan is a collectively bargained plan	No
2013-10-01	Plan funding arrangement – Insurance	Yes
2013-10-01	Plan funding arrangement – Trust	Yes
2013-10-01	Plan benefit arrangement - Trust	Yes
2012: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-10-01	Type of plan entity	Single employer plan
2012-10-01	Submission has been amended	Yes
2012-10-01	This submission is the final filing	No
2012-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-10-01	Plan is a collectively bargained plan	No
2012-10-01	Plan funding arrangement – Insurance	Yes
2012-10-01	Plan funding arrangement – Trust	Yes
2012-10-01	Plan benefit arrangement - Trust	Yes
2011: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-10-01	Type of plan entity	Single employer plan
2011-10-01	Submission has been amended	Yes
2011-10-01	This submission is the final filing	No
2011-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-10-01	Plan is a collectively bargained plan	No
2011-10-01	Plan funding arrangement – Insurance	Yes
2011-10-01	Plan funding arrangement – Trust	Yes
2011-10-01	Plan benefit arrangement - Trust	Yes
2010: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-10-01	Type of plan entity	Single employer plan
2010-10-01	Submission has been amended	No
2010-10-01	This submission is the final filing	No
2010-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-10-01	Plan is a collectively bargained plan	No
2010-10-01	Plan funding arrangement – Insurance	Yes
2010-10-01	Plan funding arrangement – Trust	Yes
2010-10-01	Plan benefit arrangement - Trust	Yes
2009: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-10-01	Type of plan entity	Single employer plan
2009-10-01	Submission has been amended	No
2009-10-01	This submission is the final filing	No
2009-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-10-01	Plan is a collectively bargained plan	No
2009-10-01	Plan funding arrangement – Insurance	Yes
2009-10-01	Plan funding arrangement – Trust	Yes
2009-10-01	Plan benefit arrangement - Trust	Yes
2008: RETINA VITREOUS CENTER, P.C. 401(K) PROFIT SHARING PLAN 2008 form 5500 responses
2008-10-01	Type of plan entity	Single employer plan
2008-10-01	Submission has been amended	No
2008-10-01	This submission is the final filing	No
2008-10-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-10-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

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

Policy contract number

48020

Policy instance

Insurance contract or identification number	48020
Number of Individuals Covered	0
Insurance policy start date	2015-10-01
Insurance policy end date	2015-11-30
Total amount of commissions paid to insurance broker	USD $467
Total amount of fees paid to insurance company	USD $1,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $467
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	RETIREMENT PLAN ADMINISTRATORS

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

Policy contract number

48020

Policy instance

Insurance contract or identification number	48020
Number of Individuals Covered	18
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $1,865
Total amount of fees paid to insurance company	USD $2,192
Are there contracts with unallocated funds for contracts of type 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 $1,865
Insurance broker organization code?	3
Amount paid for insurance broker fees	2192
Insurance broker name	RETIREMENT PLAN ADMINISTRATORS

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

Policy contract number

48020

Policy instance

Insurance contract or identification number	48020
Number of Individuals Covered	20
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $747
Total amount of fees paid to insurance company	USD $44
Are there contracts with unallocated funds for contracts of type 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 $747
Insurance broker organization code?	3
Amount paid for insurance broker fees	44
Insurance broker name	RETIREMENT PLAN ADMINISTRATORS

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

Policy contract number

48020

Policy instance

Insurance contract or identification number	48020
Number of Individuals Covered	20
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $587
Total amount of fees paid to insurance company	USD $69
Are there contracts with unallocated funds for contracts of type 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 $587
Insurance broker organization code?	3
Amount paid for insurance broker fees	69
Additional information about fees paid to insurance broker	TPA COMPENSATION OTHER ALLOWANCES
Insurance broker name	RETIREMENT PLAN ADMINISTRATORS

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

Policy contract number

48020

Policy instance

Insurance contract or identification number	48020
Number of Individuals Covered	20
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $1,236
Total amount of fees paid to insurance company	USD $103
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

48020

Policy instance

Insurance contract or identification number	48020
Number of Individuals Covered	15
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $2,094
Total amount of fees paid to insurance company	USD $111
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	RETINA VITREOUS CENTER, P.C.
Employer identification number (EIN):	383093939
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)