401k Plan data: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN plan

DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 401k Plan overview

Plan Name	DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN
Plan identification number	502

DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Long-term disability cover

401k Sponsoring company profile

DERMATOLOGY CONSULTANTS, P.A. has sponsored the creation of one or more 401k plans.

Company Name: DERMATOLOGY CONSULTANTS, P.A.

Employer identification number (EIN): 410972960

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

Additional information about DERMATOLOGY CONSULTANTS, P.A.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations

Incorporation Date: 2005-11-21

Company Identification Number: P05000154118

Legal Registered Office Address: 3019 JUNIPER LANE

DAVIE

33330

More information about DERMATOLOGY CONSULTANTS, P.A.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2016-01-01 WILLIAM O. KENNEY
502 2015-08-01 WILLIAM O. KENNEY
502 2015-08-01 WILLIAM O. KENNEY
502 2014-08-01 WILLIAM O. KENNEY
502 2013-08-01 WILLIAM O. KENNEY
502 2012-08-01 WILLIAM O. KENNEY

Plan id#	Filing Submission Date	Name of Administrator
502	2016-01-01	WILLIAM O. KENNEY
502	2015-08-01	WILLIAM O. KENNEY
502	2015-08-01	WILLIAM O. KENNEY
502	2014-08-01	WILLIAM O. KENNEY
502	2013-08-01	WILLIAM O. KENNEY
502	2012-08-01	WILLIAM O. KENNEY

Plan Statistics for DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN

401k plan membership statisitcs for DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN

Measure Date Value
2016: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 136
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
2015: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year 2015-08-01 126
Total number of active participants reported on line 7a of the Form 5500 2015-08-01 136
Number of retired or separated participants receiving benefits 2015-08-01 0
Number of other retired or separated participants entitled to future benefits 2015-08-01 0
Total of all active and inactive participants 2015-08-01 136
2014: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year 2014-08-01 113
Total number of active participants reported on line 7a of the Form 5500 2014-08-01 120
Number of retired or separated participants receiving benefits 2014-08-01 0
Number of other retired or separated participants entitled to future benefits 2014-08-01 0
Total of all active and inactive participants 2014-08-01 120
2013: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year 2013-08-01 105
Total number of active participants reported on line 7a of the Form 5500 2013-08-01 113
Number of retired or separated participants receiving benefits 2013-08-01 0
Number of other retired or separated participants entitled to future benefits 2013-08-01 0
Total of all active and inactive participants 2013-08-01 113
2012: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year 2012-08-01 100
Total number of active participants reported on line 7a of the Form 5500 2012-08-01 105
Number of retired or separated participants receiving benefits 2012-08-01 0
Number of other retired or separated participants entitled to future benefits 2012-08-01 0
Total of all active and inactive participants 2012-08-01 105

Measure	Date	Value
2016: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	136
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
2015: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2015 401k membership
Total participants, beginning-of-year	2015-08-01	126
Total number of active participants reported on line 7a of the Form 5500	2015-08-01	136
Number of retired or separated participants receiving benefits	2015-08-01	0
Number of other retired or separated participants entitled to future benefits	2015-08-01	0
Total of all active and inactive participants	2015-08-01	136
2014: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2014 401k membership
Total participants, beginning-of-year	2014-08-01	113
Total number of active participants reported on line 7a of the Form 5500	2014-08-01	120
Number of retired or separated participants receiving benefits	2014-08-01	0
Number of other retired or separated participants entitled to future benefits	2014-08-01	0
Total of all active and inactive participants	2014-08-01	120
2013: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2013 401k membership
Total participants, beginning-of-year	2013-08-01	105
Total number of active participants reported on line 7a of the Form 5500	2013-08-01	113
Number of retired or separated participants receiving benefits	2013-08-01	0
Number of other retired or separated participants entitled to future benefits	2013-08-01	0
Total of all active and inactive participants	2013-08-01	113
2012: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2012 401k membership
Total participants, beginning-of-year	2012-08-01	100
Total number of active participants reported on line 7a of the Form 5500	2012-08-01	105
Number of retired or separated participants receiving benefits	2012-08-01	0
Number of other retired or separated participants entitled to future benefits	2012-08-01	0
Total of all active and inactive participants	2012-08-01	105

Form 5500 Responses for DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN

2016: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	Yes
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2015 form 5500 responses
2015-08-01	Type of plan entity	Single employer plan
2015-08-01	Submission has been amended	Yes
2015-08-01	This submission is the final filing	No
2015-08-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-08-01	Plan is a collectively bargained plan	No
2015-08-01	Plan funding arrangement – Insurance	Yes
2015-08-01	Plan benefit arrangement – Insurance	Yes
2014: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2014 form 5500 responses
2014-08-01	Type of plan entity	Single employer plan
2014-08-01	Submission has been amended	No
2014-08-01	This submission is the final filing	No
2014-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-08-01	Plan is a collectively bargained plan	No
2014-08-01	Plan funding arrangement – Insurance	Yes
2014-08-01	Plan benefit arrangement – Insurance	Yes
2013: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2013 form 5500 responses
2013-08-01	Type of plan entity	Single employer plan
2013-08-01	Submission has been amended	No
2013-08-01	This submission is the final filing	No
2013-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-08-01	Plan is a collectively bargained plan	No
2013-08-01	Plan funding arrangement – Insurance	Yes
2013-08-01	Plan benefit arrangement – Insurance	Yes
2012: DERMATOLOGY CONSULTANTS, P. A. GROUP LONG TERM DISABILITY PLAN 2012 form 5500 responses
2012-08-01	Type of plan entity	Single employer plan
2012-08-01	First time form 5500 has been submitted	Yes
2012-08-01	Submission has been amended	No
2012-08-01	This submission is the final filing	No
2012-08-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-08-01	Plan is a collectively bargained plan	No
2012-08-01	Plan funding arrangement – Insurance	Yes
2012-08-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

676451G

Policy instance

Insurance contract or identification number	676451G
Number of Individuals Covered	136
Insurance policy start date	2015-10-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $1,812
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $12,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,812
Insurance broker organization code?	3
Insurance broker name	WILLIS OF MINNESOTA INC.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD218282

Policy instance

Insurance contract or identification number	LTD218282
Number of Individuals Covered	127
Insurance policy start date	2015-08-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $2,453
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $14,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,453
Insurance broker organization code?	3
Insurance broker name	WILLIS OF MINNESOTA, INC.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD218282

Policy instance

Insurance contract or identification number	LTD218282
Number of Individuals Covered	120
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $7,732
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $70,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,732
Insurance broker organization code?	3
Insurance broker name	NORTH RISK PARTNERS, LLC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD218282

Policy instance

Insurance contract or identification number	LTD218282
Number of Individuals Covered	113
Insurance policy start date	2013-08-01
Insurance policy end date	2014-07-31
Total amount of commissions paid to insurance broker	USD $7,909
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $65,909
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,493
Insurance broker organization code?	3
Insurance broker name	NORTH RISK PARTNERS, LLC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

LTD218282

Policy instance

Insurance contract or identification number	LTD218282
Number of Individuals Covered	105
Insurance policy start date	2012-08-01
Insurance policy end date	2013-07-31
Total amount of commissions paid to insurance broker	USD $7,579
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $63,157
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,579
Insurance broker organization code?	3
Insurance broker name	JOHNSON MCCANN BENEFITS, LLC

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Company Name:	DERMATOLOGY CONSULTANTS, P.A.
Employer identification number (EIN):	410972960
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)

Jurisdiction of Incorporation:	Florida Department of State Division of Corporations
Incorporation Date:	2005-11-21
Company Identification Number:	P05000154118
Legal Registered Office Address:	3019 JUNIPER LANE DAVIE 33330