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WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameWAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN
Plan identification number 002

WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) 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.
  • 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

WAUKESHA SURGICAL SPECIALISTS, S.C. has sponsored the creation of one or more 401k plans.

Company Name:WAUKESHA SURGICAL SPECIALISTS, S.C.
Employer identification number (EIN):391228742
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022021-11-01DR. THOMAS WADE2023-07-31
0022020-11-01DR. KELLI K PETTIT2022-07-31
0022019-11-01DR. KELLI K PETTIT2021-08-10
0022018-11-01CHRISTOPHER B. DAVIES2020-06-29
0022017-11-01ARCHEBALD J. PEQUET2019-05-27
0022016-11-01
0022015-11-01ARCHEBALD J. PEQUET
0022014-11-01ARCHEBALD J. PEQUET
0022013-11-01ARCHEBALD J. PEQUET
0022012-11-01ARCHEBALD J. PEQUET
0022011-11-01ACRCHEBALD J. PEQUET
0022009-11-01ARCHEBALD J. PEQUET
0022008-11-01

Plan Statistics for WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN

Measure Date Value
2021: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year2021-11-0140
Total number of active participants reported on line 7a of the Form 55002021-11-0127
Number of retired or separated participants receiving benefits2021-11-014
Number of other retired or separated participants entitled to future benefits2021-11-018
Total of all active and inactive participants2021-11-0139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-11-010
Total participants2021-11-0139
Number of participants with account balances2021-11-0139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-11-013
2020: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-11-0139
Total number of active participants reported on line 7a of the Form 55002020-11-0132
Number of retired or separated participants receiving benefits2020-11-014
Number of other retired or separated participants entitled to future benefits2020-11-014
Total of all active and inactive participants2020-11-0140
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-11-010
Total participants2020-11-0140
Number of participants with account balances2020-11-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-11-011
2019: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-11-0137
Total number of active participants reported on line 7a of the Form 55002019-11-0131
Number of retired or separated participants receiving benefits2019-11-011
Number of other retired or separated participants entitled to future benefits2019-11-017
Total of all active and inactive participants2019-11-0139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-11-010
Total participants2019-11-0139
Number of participants with account balances2019-11-0139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-11-010
2018: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-11-0133
Total number of active participants reported on line 7a of the Form 55002018-11-0130
Number of retired or separated participants receiving benefits2018-11-010
Number of other retired or separated participants entitled to future benefits2018-11-016
Total of all active and inactive participants2018-11-0136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-11-010
Total participants2018-11-0136
Number of participants with account balances2018-11-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-11-010
2017: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-11-0132
Total number of active participants reported on line 7a of the Form 55002017-11-0128
Number of retired or separated participants receiving benefits2017-11-010
Number of other retired or separated participants entitled to future benefits2017-11-015
Total of all active and inactive participants2017-11-0133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-11-010
Total participants2017-11-0133
Number of participants with account balances2017-11-0133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-11-011
2016: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-11-0132
Total number of active participants reported on line 7a of the Form 55002016-11-0128
Number of retired or separated participants receiving benefits2016-11-010
Number of other retired or separated participants entitled to future benefits2016-11-014
Total of all active and inactive participants2016-11-0132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-11-010
Total participants2016-11-0132
Number of participants with account balances2016-11-0132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-11-010
2015: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-11-0129
Total number of active participants reported on line 7a of the Form 55002015-11-0125
Number of retired or separated participants receiving benefits2015-11-010
Number of other retired or separated participants entitled to future benefits2015-11-017
Total of all active and inactive participants2015-11-0132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-11-010
Total participants2015-11-0132
Number of participants with account balances2015-11-0132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-11-012
2014: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-0130
Total number of active participants reported on line 7a of the Form 55002014-11-0125
Number of retired or separated participants receiving benefits2014-11-010
Number of other retired or separated participants entitled to future benefits2014-11-014
Total of all active and inactive participants2014-11-0129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-11-010
Total participants2014-11-0129
Number of participants with account balances2014-11-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-11-011
2013: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-0130
Total number of active participants reported on line 7a of the Form 55002013-11-0126
Number of retired or separated participants receiving benefits2013-11-010
Number of other retired or separated participants entitled to future benefits2013-11-014
Total of all active and inactive participants2013-11-0130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-11-010
Total participants2013-11-0130
Number of participants with account balances2013-11-0130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-11-010
2012: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-11-0129
Total number of active participants reported on line 7a of the Form 55002012-11-0127
Number of retired or separated participants receiving benefits2012-11-010
Number of other retired or separated participants entitled to future benefits2012-11-014
Total of all active and inactive participants2012-11-0131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-11-010
Total participants2012-11-0131
Number of participants with account balances2012-11-0130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-11-011
2011: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-11-0129
Total number of active participants reported on line 7a of the Form 55002011-11-0126
Number of retired or separated participants receiving benefits2011-11-010
Number of other retired or separated participants entitled to future benefits2011-11-013
Total of all active and inactive participants2011-11-0129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-11-011
Total participants2011-11-0130
Number of participants with account balances2011-11-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-11-010
2009: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-11-0125
Total number of active participants reported on line 7a of the Form 55002009-11-0126
Number of retired or separated participants receiving benefits2009-11-010
Number of other retired or separated participants entitled to future benefits2009-11-013
Total of all active and inactive participants2009-11-0129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-11-010
Total participants2009-11-0129
Number of participants with account balances2009-11-0129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-11-010

Financial Data on WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN

Measure Date Value
2022 : WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total income from all sources2022-10-31$-4,299,424
Expenses. Total of all expenses incurred2022-10-31$4,825,861
Benefits paid (including direct rollovers)2022-10-31$4,787,148
Total plan assets at end of year2022-10-31$19,334,458
Total plan assets at beginning of year2022-10-31$28,459,743
Value of fidelity bond covering the plan2022-10-31$500,000
Total contributions received or receivable from participants2022-10-31$391,491
Other income received2022-10-31$-5,229,116
Net income (gross income less expenses)2022-10-31$-9,125,285
Net plan assets at end of year (total assets less liabilities)2022-10-31$19,334,458
Net plan assets at beginning of year (total assets less liabilities)2022-10-31$28,459,743
Assets. Value of participant loans2022-10-31$8,585
Total contributions received or receivable from employer(s)2022-10-31$538,201
Expenses. Administrative service providers (salaries,fees and commissions)2022-10-31$38,713
2021 : WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total income from all sources2021-10-31$6,984,529
Expenses. Total of all expenses incurred2021-10-31$1,323,189
Benefits paid (including direct rollovers)2021-10-31$1,260,017
Total plan assets at end of year2021-10-31$28,459,743
Total plan assets at beginning of year2021-10-31$22,798,403
Value of fidelity bond covering the plan2021-10-31$500,000
Total contributions received or receivable from participants2021-10-31$329,567
Contributions received from other sources (not participants or employers)2021-10-31$0
Other income received2021-10-31$6,103,580
Net income (gross income less expenses)2021-10-31$5,661,340
Net plan assets at end of year (total assets less liabilities)2021-10-31$28,459,743
Net plan assets at beginning of year (total assets less liabilities)2021-10-31$22,798,403
Assets. Value of participant loans2021-10-31$8,585
Total contributions received or receivable from employer(s)2021-10-31$551,382
Value of certain deemed distributions of participant loans2021-10-31$0
Value of corrective distributions2021-10-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2021-10-31$63,172
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-10-31$0
2020 : WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total income from all sources2020-10-31$2,103,962
Expenses. Total of all expenses incurred2020-10-31$478,669
Benefits paid (including direct rollovers)2020-10-31$424,002
Total plan assets at end of year2020-10-31$22,798,403
Total plan assets at beginning of year2020-10-31$21,173,110
Value of fidelity bond covering the plan2020-10-31$500,000
Total contributions received or receivable from participants2020-10-31$335,727
Other income received2020-10-31$1,259,928
Net income (gross income less expenses)2020-10-31$1,625,293
Net plan assets at end of year (total assets less liabilities)2020-10-31$22,798,403
Net plan assets at beginning of year (total assets less liabilities)2020-10-31$21,173,110
Assets. Value of participant loans2020-10-31$14,382
Total contributions received or receivable from employer(s)2020-10-31$508,307
Expenses. Administrative service providers (salaries,fees and commissions)2020-10-31$54,667
2019 : WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total income from all sources2019-10-31$2,962,581
Expenses. Total of all expenses incurred2019-10-31$604,156
Benefits paid (including direct rollovers)2019-10-31$552,095
Total plan assets at end of year2019-10-31$21,173,110
Total plan assets at beginning of year2019-10-31$18,814,685
Value of fidelity bond covering the plan2019-10-31$500,000
Total contributions received or receivable from participants2019-10-31$315,462
Other income received2019-10-31$2,165,385
Net income (gross income less expenses)2019-10-31$2,358,425
Net plan assets at end of year (total assets less liabilities)2019-10-31$21,173,110
Net plan assets at beginning of year (total assets less liabilities)2019-10-31$18,814,685
Assets. Value of participant loans2019-10-31$20,062
Total contributions received or receivable from employer(s)2019-10-31$481,734
Expenses. Administrative service providers (salaries,fees and commissions)2019-10-31$52,061
2017 : WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources2017-10-31$3,238,245
Expenses. Total of all expenses incurred2017-10-31$324,099
Benefits paid (including direct rollovers)2017-10-31$274,364
Total plan assets at end of year2017-10-31$18,406,599
Total plan assets at beginning of year2017-10-31$15,492,453
Value of fidelity bond covering the plan2017-10-31$500,000
Total contributions received or receivable from participants2017-10-31$242,426
Contributions received from other sources (not participants or employers)2017-10-31$38,903
Other income received2017-10-31$2,576,682
Net income (gross income less expenses)2017-10-31$2,914,146
Net plan assets at end of year (total assets less liabilities)2017-10-31$18,406,599
Net plan assets at beginning of year (total assets less liabilities)2017-10-31$15,492,453
Assets. Value of participant loans2017-10-31$24,977
Total contributions received or receivable from employer(s)2017-10-31$380,234
Expenses. Administrative service providers (salaries,fees and commissions)2017-10-31$49,735
2016 : WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-10-31$1,130,378
Expenses. Total of all expenses incurred2016-10-31$478,583
Benefits paid (including direct rollovers)2016-10-31$435,923
Total plan assets at end of year2016-10-31$15,492,453
Total plan assets at beginning of year2016-10-31$14,840,658
Value of fidelity bond covering the plan2016-10-31$500,000
Total contributions received or receivable from participants2016-10-31$221,831
Other income received2016-10-31$525,303
Net income (gross income less expenses)2016-10-31$651,795
Net plan assets at end of year (total assets less liabilities)2016-10-31$15,492,453
Net plan assets at beginning of year (total assets less liabilities)2016-10-31$14,840,658
Assets. Value of participant loans2016-10-31$12,070
Total contributions received or receivable from employer(s)2016-10-31$383,244
Expenses. Administrative service providers (salaries,fees and commissions)2016-10-31$42,660
2015 : WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-10-31$840,054
Expenses. Total of all expenses incurred2015-10-31$1,686,305
Benefits paid (including direct rollovers)2015-10-31$1,643,713
Total plan assets at end of year2015-10-31$14,840,658
Total plan assets at beginning of year2015-10-31$15,686,909
Value of fidelity bond covering the plan2015-10-31$500,000
Total contributions received or receivable from participants2015-10-31$236,751
Contributions received from other sources (not participants or employers)2015-10-31$12,906
Other income received2015-10-31$240,512
Net income (gross income less expenses)2015-10-31$-846,251
Net plan assets at end of year (total assets less liabilities)2015-10-31$14,840,658
Net plan assets at beginning of year (total assets less liabilities)2015-10-31$15,686,909
Assets. Value of participant loans2015-10-31$8,851
Total contributions received or receivable from employer(s)2015-10-31$349,885
Expenses. Administrative service providers (salaries,fees and commissions)2015-10-31$42,592
2014 : WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-10-31$1,836,815
Expenses. Total of all expenses incurred2014-10-31$216,269
Benefits paid (including direct rollovers)2014-10-31$173,241
Total plan assets at end of year2014-10-31$15,686,909
Total plan assets at beginning of year2014-10-31$14,066,363
Value of fidelity bond covering the plan2014-10-31$500,000
Total contributions received or receivable from participants2014-10-31$258,413
Other income received2014-10-31$1,177,297
Net income (gross income less expenses)2014-10-31$1,620,546
Net plan assets at end of year (total assets less liabilities)2014-10-31$15,686,909
Net plan assets at beginning of year (total assets less liabilities)2014-10-31$14,066,363
Assets. Value of participant loans2014-10-31$4,264
Total contributions received or receivable from employer(s)2014-10-31$401,105
Expenses. Administrative service providers (salaries,fees and commissions)2014-10-31$43,028
2013 : WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-10-31$2,843,366
Expenses. Total of all expenses incurred2013-10-31$2,796,739
Benefits paid (including direct rollovers)2013-10-31$2,749,333
Total plan assets at end of year2013-10-31$14,066,363
Total plan assets at beginning of year2013-10-31$14,019,736
Value of fidelity bond covering the plan2013-10-31$400,000
Total contributions received or receivable from participants2013-10-31$258,222
Other income received2013-10-31$2,182,248
Net income (gross income less expenses)2013-10-31$46,627
Net plan assets at end of year (total assets less liabilities)2013-10-31$14,066,363
Net plan assets at beginning of year (total assets less liabilities)2013-10-31$14,019,736
Total contributions received or receivable from employer(s)2013-10-31$402,896
Expenses. Administrative service providers (salaries,fees and commissions)2013-10-31$47,406
2012 : WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-10-31$1,975,094
Expenses. Total of all expenses incurred2012-10-31$847,148
Benefits paid (including direct rollovers)2012-10-31$810,843
Total plan assets at end of year2012-10-31$14,019,736
Total plan assets at beginning of year2012-10-31$12,891,790
Value of fidelity bond covering the plan2012-10-31$400,000
Total contributions received or receivable from participants2012-10-31$248,123
Expenses. Other expenses not covered elsewhere2012-10-31$3,569
Other income received2012-10-31$1,335,629
Net income (gross income less expenses)2012-10-31$1,127,946
Net plan assets at end of year (total assets less liabilities)2012-10-31$14,019,736
Net plan assets at beginning of year (total assets less liabilities)2012-10-31$12,891,790
Total contributions received or receivable from employer(s)2012-10-31$391,342
Expenses. Administrative service providers (salaries,fees and commissions)2012-10-31$32,736
2011 : WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-10-31$976,937
Expenses. Total of all expenses incurred2011-10-31$540,721
Benefits paid (including direct rollovers)2011-10-31$481,508
Total plan assets at end of year2011-10-31$12,898,830
Total plan assets at beginning of year2011-10-31$12,462,614
Value of fidelity bond covering the plan2011-10-31$400,000
Total contributions received or receivable from participants2011-10-31$236,516
Expenses. Other expenses not covered elsewhere2011-10-31$2,355
Other income received2011-10-31$389,997
Net income (gross income less expenses)2011-10-31$436,216
Net plan assets at end of year (total assets less liabilities)2011-10-31$12,898,830
Net plan assets at beginning of year (total assets less liabilities)2011-10-31$12,462,614
Total contributions received or receivable from employer(s)2011-10-31$350,424
Expenses. Administrative service providers (salaries,fees and commissions)2011-10-31$56,858

Form 5500 Responses for WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN

2021: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-11-01Type of plan entitySingle employer plan
2021-11-01Submission has been amendedNo
2021-11-01This submission is the final filingNo
2021-11-01This return/report is a short plan year return/report (less than 12 months)No
2021-11-01Plan is a collectively bargained planNo
2021-11-01Plan funding arrangement – InsuranceYes
2021-11-01Plan funding arrangement – TrustYes
2021-11-01Plan benefit arrangement – InsuranceYes
2021-11-01Plan benefit arrangement - TrustYes
2020: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-11-01Type of plan entitySingle employer plan
2020-11-01Submission has been amendedNo
2020-11-01This submission is the final filingNo
2020-11-01This return/report is a short plan year return/report (less than 12 months)No
2020-11-01Plan is a collectively bargained planNo
2020-11-01Plan funding arrangement – InsuranceYes
2020-11-01Plan funding arrangement – TrustYes
2020-11-01Plan benefit arrangement – InsuranceYes
2020-11-01Plan benefit arrangement - TrustYes
2019: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-11-01Type of plan entitySingle employer plan
2019-11-01Submission has been amendedNo
2019-11-01This submission is the final filingNo
2019-11-01This return/report is a short plan year return/report (less than 12 months)No
2019-11-01Plan is a collectively bargained planNo
2019-11-01Plan funding arrangement – InsuranceYes
2019-11-01Plan funding arrangement – TrustYes
2019-11-01Plan benefit arrangement – InsuranceYes
2019-11-01Plan benefit arrangement - TrustYes
2018: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-11-01Type of plan entitySingle employer plan
2018-11-01Submission has been amendedNo
2018-11-01This submission is the final filingNo
2018-11-01This return/report is a short plan year return/report (less than 12 months)No
2018-11-01Plan is a collectively bargained planNo
2018-11-01Plan funding arrangement – InsuranceYes
2018-11-01Plan funding arrangement – TrustYes
2018-11-01Plan benefit arrangement – InsuranceYes
2018-11-01Plan benefit arrangement - TrustYes
2017: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-11-01Type of plan entitySingle employer plan
2017-11-01Submission has been amendedNo
2017-11-01This submission is the final filingNo
2017-11-01This return/report is a short plan year return/report (less than 12 months)No
2017-11-01Plan is a collectively bargained planNo
2017-11-01Plan funding arrangement – InsuranceYes
2017-11-01Plan funding arrangement – TrustYes
2017-11-01Plan benefit arrangement – InsuranceYes
2017-11-01Plan benefit arrangement - TrustYes
2016: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2016 form 5500 responses
2016-11-01Type of plan entitySingle employer plan
2016-11-01Submission has been amendedNo
2016-11-01This submission is the final filingNo
2016-11-01This return/report is a short plan year return/report (less than 12 months)No
2016-11-01Plan is a collectively bargained planNo
2016-11-01Plan funding arrangement – InsuranceYes
2016-11-01Plan funding arrangement – TrustYes
2016-11-01Plan benefit arrangement – InsuranceYes
2016-11-01Plan benefit arrangement - TrustYes
2015: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-11-01Type of plan entitySingle employer plan
2015-11-01Submission has been amendedNo
2015-11-01This submission is the final filingNo
2015-11-01This return/report is a short plan year return/report (less than 12 months)No
2015-11-01Plan is a collectively bargained planNo
2015-11-01Plan funding arrangement – InsuranceYes
2015-11-01Plan funding arrangement – TrustYes
2015-11-01Plan benefit arrangement – InsuranceYes
2015-11-01Plan benefit arrangement - TrustYes
2014: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan funding arrangement – TrustYes
2014-11-01Plan benefit arrangement – InsuranceYes
2014-11-01Plan benefit arrangement - TrustYes
2013: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan funding arrangement – TrustYes
2013-11-01Plan benefit arrangement – InsuranceYes
2013-11-01Plan benefit arrangement - TrustYes
2012: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan funding arrangement – TrustYes
2012-11-01Plan benefit arrangement – InsuranceYes
2012-11-01Plan benefit arrangement - TrustYes
2011: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Submission has been amendedNo
2011-11-01This submission is the final filingNo
2011-11-01This return/report is a short plan year return/report (less than 12 months)No
2011-11-01Plan is a collectively bargained planNo
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan funding arrangement – TrustYes
2011-11-01Plan benefit arrangement – InsuranceYes
2011-11-01Plan benefit arrangement - TrustYes
2009: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-11-01Type of plan entitySingle employer plan
2009-11-01Submission has been amendedNo
2009-11-01This submission is the final filingNo
2009-11-01This return/report is a short plan year return/report (less than 12 months)No
2009-11-01Plan is a collectively bargained planNo
2009-11-01Plan funding arrangement – InsuranceYes
2009-11-01Plan funding arrangement – TrustYes
2009-11-01Plan benefit arrangement – InsuranceYes
2009-11-01Plan benefit arrangement - TrustYes
2008: WAUKESHA SURGICAL SPECIALISTS, S.C. 401(K) PROFIT SHARING PLAN 2008 form 5500 responses
2008-11-01Type of plan entitySingle employer plan
2008-11-01Submission has been amendedNo
2008-11-01This submission is the final filingNo
2008-11-01This return/report is a short plan year return/report (less than 12 months)No
2008-11-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number53090
Policy instance 2
Insurance contract or identification number53090
Number of Individuals Covered1
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number782706850 PR
Policy instance 1
Insurance contract or identification number782706850 PR
Number of Individuals Covered0
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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
JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 )
Policy contract number1015503064
Policy instance 1
Insurance contract or identification number1015503064
Number of Individuals Covered1
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $5,405
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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
Commission paid to Insurance BrokerUSD $5,405
Insurance broker organization code?6
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number782706850 PR
Policy instance 2
Insurance contract or identification number782706850 PR
Number of Individuals Covered1
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number53090
Policy instance 3
Insurance contract or identification number53090
Number of Individuals Covered1
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number53090
Policy instance 2
Insurance contract or identification number53090
Number of Individuals Covered1
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number782706850 PR
Policy instance 1
Insurance contract or identification number782706850 PR
Number of Individuals Covered1
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $0
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?Yes
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
Other information about contractLIFE INSUARNCE
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number53090
Policy instance 2
Insurance contract or identification number53090
Number of Individuals Covered1
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number782706850 PR
Policy instance 1
Insurance contract or identification number782706850 PR
Number of Individuals Covered1
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $0
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?Yes
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
Other information about contractLIFE INSUARNCE
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number53090
Policy instance 2
Insurance contract or identification number53090
Number of Individuals Covered1
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number782706850 PR
Policy instance 1
Insurance contract or identification number782706850 PR
Number of Individuals Covered1
Insurance policy start date2017-11-01
Insurance policy end date2018-10-31
Total amount of commissions paid to insurance brokerUSD $0
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?Yes
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
Other information about contractLIFE INSUARNCE
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number782706850 PR
Policy instance 1
Insurance contract or identification number782706850 PR
Number of Individuals Covered1
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Total amount of commissions paid to insurance brokerUSD $0
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?Yes
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
Other information about contractLIFE INSUARNCE
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number53090
Policy instance 2
Insurance contract or identification number53090
Number of Individuals Covered1
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number53090
Policy instance 2
Insurance contract or identification number53090
Number of Individuals Covered1
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number782706850 PR
Policy instance 1
Insurance contract or identification number782706850 PR
Number of Individuals Covered1
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $0
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?Yes
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
Other information about contractLIFE INSUARNCE
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number782706850 PR
Policy instance 1
Insurance contract or identification number782706850 PR
Number of Individuals Covered1
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $0
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?Yes
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
Other information about contractLIFE INSUARNCE
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number53090
Policy instance 2
Insurance contract or identification number53090
Number of Individuals Covered1
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number15937
Policy instance 2
Insurance contract or identification number15937
Number of Individuals Covered1
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number782706850 PR
Policy instance 1
Insurance contract or identification number782706850 PR
Number of Individuals Covered1
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $0
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?Yes
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
Other information about contractLIFE INSUARNCE
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number53090
Policy instance 3
Insurance contract or identification number53090
Number of Individuals Covered1
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number53090
Policy instance 3
Insurance contract or identification number53090
Number of Individuals Covered1
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number15937
Policy instance 2
Insurance contract or identification number15937
Number of Individuals Covered1
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number782706850 PR
Policy instance 1
Insurance contract or identification number782706850 PR
Number of Individuals Covered1
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $0
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?Yes
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
Other information about contractLIFE INSUARNCE

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