401k Plan data: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN plan

MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 401k Plan overview

Plan Name	MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN
Plan identification number	001

MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN Benefits

401k Plan Type

Defined 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.
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.
Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

MINNESOTA HEAD & NECK PAIN CLINIC, P.A. has sponsored the creation of one or more 401k plans.

Company Name: MINNESOTA HEAD & NECK PAIN CLINIC, P.A.

Employer identification number (EIN): 411526541

NAIC Classification: 621112
NAIC Description: Offices of Physicians, Mental Health Specialists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 CORY HERMAN
001 2017-01-01 CORY HERMAN
001 2016-01-01 CORY R HERMAN
001 2015-01-01 CORY R HERMAN
001 2014-01-01 CORY HERMAN CORY HERMAN 2015-07-14
001 2013-01-01 CORY HERMAN 2014-07-30
001 2012-01-01 CORY HERMAN 2013-06-03
001 2011-01-01 CORY HERMAN 2012-06-28
001 2010-01-01 CORY HERMAN
001 2009-01-01 CORY HERMAN
001 2009-01-01 CORY HERMAN
001 2008-01-01 CORY HERMAN
001 2008-01-01 CORY HERMAN
001 2007-01-01 CORY HERMAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01	CORY HERMAN
001	2017-01-01	CORY HERMAN
001	2016-01-01	CORY R HERMAN
001	2015-01-01	CORY R HERMAN
001	2014-01-01	CORY HERMAN		CORY HERMAN	2015-07-14
001	2013-01-01	CORY HERMAN	2014-07-30
001	2012-01-01	CORY HERMAN	2013-06-03
001	2011-01-01	CORY HERMAN	2012-06-28
001	2010-01-01	CORY HERMAN
001	2009-01-01	CORY HERMAN
001	2009-01-01	CORY HERMAN
001	2008-01-01	CORY HERMAN
001	2008-01-01	CORY HERMAN
001	2007-01-01	CORY HERMAN

Plan Statistics for MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN

401k plan membership statisitcs for MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN

Measure Date Value
2022: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 45
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 37
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 11
Total of all active and inactive participants 2022-01-01 48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 48
Number of participants with account balances 2022-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 1
2021: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 44
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 35
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 10
Total of all active and inactive participants 2021-01-01 45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 45
Number of participants with account balances 2021-01-01 38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 0
2020: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 44
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 32
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 12
Total of all active and inactive participants 2020-01-01 44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 44
Number of participants with account balances 2020-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 46
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 37
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 7
Total of all active and inactive participants 2019-01-01 44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 44
Number of participants with account balances 2019-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 34
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 37
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 9
Total of all active and inactive participants 2018-01-01 46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 46
Number of participants with account balances 2018-01-01 35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 1
2017: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 33
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 29
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 5
Total of all active and inactive participants 2017-01-01 34
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 34
Number of participants with account balances 2017-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 33
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 28
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 5
Total of all active and inactive participants 2016-01-01 33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 33
Number of participants with account balances 2016-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 32
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 27
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 6
Total of all active and inactive participants 2015-01-01 33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 33
Number of participants with account balances 2015-01-01 28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 30
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 26
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 6
Total of all active and inactive participants 2014-01-01 32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 32
Number of participants with account balances 2014-01-01 31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2010: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 44
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 33
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 9
Total of all active and inactive participants 2010-01-01 42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 42
Number of participants with account balances 2010-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 43
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 36
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 8
Total of all active and inactive participants 2009-01-01 44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 44
Number of participants with account balances 2009-01-01 36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1
2008: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2008 401k membership
Total participants, beginning-of-year 2008-01-01 30
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 31
Number of retired or separated participants receiving benefits 2008-01-01 0
Number of other retired or separated participants entitled to future benefits 2008-01-01 10
Total of all active and inactive participants 2008-01-01 41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2008-01-01 0
Total participants 2008-01-01 41
Number of participants with account balances 2008-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2008-01-01 1
2007: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2007 401k membership
Total participants, beginning-of-year 2007-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 34
Number of retired or separated participants receiving benefits 2007-01-01 0
Number of other retired or separated participants entitled to future benefits 2007-01-01 7
Total of all active and inactive participants 2007-01-01 41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2007-01-01 0
Total participants 2007-01-01 41
Number of participants with account balances 2007-01-01 24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2007-01-01 2

Measure	Date	Value
2022: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	45
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	37
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	11
Total of all active and inactive participants	2022-01-01	48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	48
Number of participants with account balances	2022-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	1
2021: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	44
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	35
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	10
Total of all active and inactive participants	2021-01-01	45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	45
Number of participants with account balances	2021-01-01	38
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	0
2020: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	44
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	32
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	12
Total of all active and inactive participants	2020-01-01	44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	44
Number of participants with account balances	2020-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	46
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	37
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	7
Total of all active and inactive participants	2019-01-01	44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	44
Number of participants with account balances	2019-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	34
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	37
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	9
Total of all active and inactive participants	2018-01-01	46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	46
Number of participants with account balances	2018-01-01	35
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	1
2017: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	33
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	29
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	5
Total of all active and inactive participants	2017-01-01	34
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	34
Number of participants with account balances	2017-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	33
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	28
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	5
Total of all active and inactive participants	2016-01-01	33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	33
Number of participants with account balances	2016-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	32
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	27
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	6
Total of all active and inactive participants	2015-01-01	33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	33
Number of participants with account balances	2015-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	30
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	26
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	6
Total of all active and inactive participants	2014-01-01	32
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	32
Number of participants with account balances	2014-01-01	31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2010: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	44
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	33
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	9
Total of all active and inactive participants	2010-01-01	42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	42
Number of participants with account balances	2010-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	43
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	36
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	8
Total of all active and inactive participants	2009-01-01	44
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	44
Number of participants with account balances	2009-01-01	36
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1
2008: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2008 401k membership
Total participants, beginning-of-year	2008-01-01	30
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	31
Number of retired or separated participants receiving benefits	2008-01-01	0
Number of other retired or separated participants entitled to future benefits	2008-01-01	10
Total of all active and inactive participants	2008-01-01	41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2008-01-01	0
Total participants	2008-01-01	41
Number of participants with account balances	2008-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2008-01-01	1
2007: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2007 401k membership
Total participants, beginning-of-year	2007-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	34
Number of retired or separated participants receiving benefits	2007-01-01	0
Number of other retired or separated participants entitled to future benefits	2007-01-01	7
Total of all active and inactive participants	2007-01-01	41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2007-01-01	0
Total participants	2007-01-01	41
Number of participants with account balances	2007-01-01	24
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2007-01-01	2

Financial Data on MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN

Measure	Date	Value
2022 : MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2022 401k financial data
Transfers to/from the plan	2022-12-31	$0
Total plan liabilities at end of year	2022-12-31	$0
Total plan liabilities at beginning of year	2022-12-31	$0
Total income from all sources	2022-12-31	$-538,242
Expenses. Total of all expenses incurred	2022-12-31	$189,303
Benefits paid (including direct rollovers)	2022-12-31	$189,203
Total plan assets at end of year	2022-12-31	$3,679,379
Total plan assets at beginning of year	2022-12-31	$4,406,924
Value of fidelity bond covering the plan	2022-12-31	$500,000
Assets. Value of tangible personal property	2022-12-31	$0
Total contributions received or receivable from participants	2022-12-31	$188,052
Assets. Value of loans (other than to participants)	2022-12-31	$0
Expenses. Other expenses not covered elsewhere	2022-12-31	$0
Contributions received from other sources (not participants or employers)	2022-12-31	$38,378
Other income received	2022-12-31	$-862,436
Noncash contributions received	2022-12-31	$0
Net income (gross income less expenses)	2022-12-31	$-727,545
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$3,679,379
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$4,406,924
Assets. Value of participant loans	2022-12-31	$10,665
Assets. Value of assets in partnership/joint-venture interests	2022-12-31	$0
Assets. Value of real-estate (other than employer real property)	2022-12-31	$0
Assets. Value of employer securities	2022-12-31	$0
Assets. Value of employer real property	2022-12-31	$0
Total contributions received or receivable from employer(s)	2022-12-31	$97,764
Value of certain deemed distributions of participant loans	2022-12-31	$0
Value of corrective distributions	2022-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$100
2021 : MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2021 401k financial data
Transfers to/from the plan	2021-12-31	$0
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$929,211
Expenses. Total of all expenses incurred	2021-12-31	$121,449
Benefits paid (including direct rollovers)	2021-12-31	$121,268
Total plan assets at end of year	2021-12-31	$4,406,924
Total plan assets at beginning of year	2021-12-31	$3,599,162
Value of fidelity bond covering the plan	2021-12-31	$500,000
Assets. Value of tangible personal property	2021-12-31	$0
Total contributions received or receivable from participants	2021-12-31	$220,098
Assets. Value of loans (other than to participants)	2021-12-31	$0
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$591,293
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$807,762
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$4,406,924
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$3,599,162
Assets. Value of participant loans	2021-12-31	$17,635
Assets. Value of assets in partnership/joint-venture interests	2021-12-31	$0
Assets. Value of real-estate (other than employer real property)	2021-12-31	$0
Assets. Value of employer securities	2021-12-31	$0
Assets. Value of employer real property	2021-12-31	$0
Total contributions received or receivable from employer(s)	2021-12-31	$117,820
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$181
2020 : MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2020 401k financial data
Transfers to/from the plan	2020-12-31	$0
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$650,867
Expenses. Total of all expenses incurred	2020-12-31	$485,656
Benefits paid (including direct rollovers)	2020-12-31	$485,518
Total plan assets at end of year	2020-12-31	$3,599,162
Total plan assets at beginning of year	2020-12-31	$3,433,951
Value of fidelity bond covering the plan	2020-12-31	$500,000
Assets. Value of tangible personal property	2020-12-31	$0
Total contributions received or receivable from participants	2020-12-31	$111,403
Assets. Value of loans (other than to participants)	2020-12-31	$0
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$24,388
Other income received	2020-12-31	$447,803
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$165,211
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$3,599,162
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$3,433,951
Assets. Value of participant loans	2020-12-31	$18,911
Assets. Value of assets in partnership/joint-venture interests	2020-12-31	$0
Assets. Value of real-estate (other than employer real property)	2020-12-31	$0
Assets. Value of employer securities	2020-12-31	$0
Assets. Value of employer real property	2020-12-31	$0
Total contributions received or receivable from employer(s)	2020-12-31	$67,273
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$138
2019 : MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$1,004,070
Expenses. Total of all expenses incurred	2019-12-31	$31,818
Benefits paid (including direct rollovers)	2019-12-31	$31,455
Total plan assets at end of year	2019-12-31	$3,433,951
Total plan assets at beginning of year	2019-12-31	$2,461,699
Value of fidelity bond covering the plan	2019-12-31	$500,000
Total contributions received or receivable from participants	2019-12-31	$145,123
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$156,153
Other income received	2019-12-31	$623,255
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$972,252
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$3,433,951
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$2,461,699
Assets. Value of participant loans	2019-12-31	$28,170
Total contributions received or receivable from employer(s)	2019-12-31	$79,539
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$363
2018 : MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2018 401k financial data
Transfers to/from the plan	2018-12-31	$0
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$0
Total income from all sources	2018-12-31	$118,255
Expenses. Total of all expenses incurred	2018-12-31	$10,498
Benefits paid (including direct rollovers)	2018-12-31	$10,304
Total plan assets at end of year	2018-12-31	$2,461,699
Total plan assets at beginning of year	2018-12-31	$2,353,942
Value of fidelity bond covering the plan	2018-12-31	$500,000
Total contributions received or receivable from participants	2018-12-31	$145,726
Expenses. Other expenses not covered elsewhere	2018-12-31	$0
Contributions received from other sources (not participants or employers)	2018-12-31	$0
Other income received	2018-12-31	$-181,363
Noncash contributions received	2018-12-31	$0
Net income (gross income less expenses)	2018-12-31	$107,757
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$2,461,699
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$2,353,942
Assets. Value of participant loans	2018-12-31	$20,838
Total contributions received or receivable from employer(s)	2018-12-31	$153,892
Value of certain deemed distributions of participant loans	2018-12-31	$0
Value of corrective distributions	2018-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$194
2017 : MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2017 401k financial data
Transfers to/from the plan	2017-12-31	$0
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$574,233
Expenses. Total of all expenses incurred	2017-12-31	$16,081
Benefits paid (including direct rollovers)	2017-12-31	$15,649
Total plan assets at end of year	2017-12-31	$2,353,942
Total plan assets at beginning of year	2017-12-31	$1,795,790
Value of fidelity bond covering the plan	2017-12-31	$500,000
Total contributions received or receivable from participants	2017-12-31	$121,020
Expenses. Other expenses not covered elsewhere	2017-12-31	$0
Contributions received from other sources (not participants or employers)	2017-12-31	$7,800
Other income received	2017-12-31	$389,795
Noncash contributions received	2017-12-31	$0
Net income (gross income less expenses)	2017-12-31	$558,152
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$2,353,942
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$1,795,790
Assets. Value of participant loans	2017-12-31	$37,237
Total contributions received or receivable from employer(s)	2017-12-31	$55,618
Value of certain deemed distributions of participant loans	2017-12-31	$188
Value of corrective distributions	2017-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$244
2016 : MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$0
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$297,359
Expenses. Total of all expenses incurred	2016-12-31	$172,500
Benefits paid (including direct rollovers)	2016-12-31	$172,312
Total plan assets at end of year	2016-12-31	$1,795,790
Total plan assets at beginning of year	2016-12-31	$1,670,931
Value of fidelity bond covering the plan	2016-12-31	$500,000
Total contributions received or receivable from participants	2016-12-31	$133,474
Expenses. Other expenses not covered elsewhere	2016-12-31	$0
Contributions received from other sources (not participants or employers)	2016-12-31	$1,509
Other income received	2016-12-31	$91,772
Noncash contributions received	2016-12-31	$0
Net income (gross income less expenses)	2016-12-31	$124,859
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,795,790
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,670,931
Assets. Value of participant loans	2016-12-31	$38,201
Total contributions received or receivable from employer(s)	2016-12-31	$70,604
Value of certain deemed distributions of participant loans	2016-12-31	$0
Value of corrective distributions	2016-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$188
2015 : MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$186,285
Expenses. Total of all expenses incurred	2015-12-31	$268,539
Benefits paid (including direct rollovers)	2015-12-31	$268,521
Total plan assets at end of year	2015-12-31	$1,670,931
Total plan assets at beginning of year	2015-12-31	$1,753,185
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$98,549
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$28,434
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-82,254
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,670,931
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,753,185
Assets. Value of participant loans	2015-12-31	$10,564
Total contributions received or receivable from employer(s)	2015-12-31	$59,302
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$18
2014 : MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$111
Total income from all sources	2014-12-31	$205,012
Expenses. Total of all expenses incurred	2014-12-31	$36,886
Benefits paid (including direct rollovers)	2014-12-31	$36,548
Total plan assets at end of year	2014-12-31	$1,753,185
Total plan assets at beginning of year	2014-12-31	$1,584,948
Value of fidelity bond covering the plan	2014-12-31	$120,000
Total contributions received or receivable from participants	2014-12-31	$105,626
Expenses. Other expenses not covered elsewhere	2014-12-31	$338
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$27,252
Net income (gross income less expenses)	2014-12-31	$168,126
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,753,185
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,584,948
Assets. Value of participant loans	2014-12-31	$7,082
Total contributions received or receivable from employer(s)	2014-12-31	$72,134
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2014-12-31	$0
Minimum employer required contribution for this plan year	2014-12-31	$0
Amount contributed by the employer to the plan for this plan year	2014-12-31	$0
2010 : MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$295,287
Expenses. Total of all expenses incurred	2010-12-31	$5,951
Benefits paid (including direct rollovers)	2010-12-31	$5,951
Total plan assets at end of year	2010-12-31	$1,091,885
Total plan assets at beginning of year	2010-12-31	$802,549
Value of fidelity bond covering the plan	2010-12-31	$100,000
Total contributions received or receivable from participants	2010-12-31	$105,846
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$1,450
Other income received	2010-12-31	$111,158
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$289,336
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,091,885
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$802,549
Assets. Value of participant loans	2010-12-31	$18,830
Total contributions received or receivable from employer(s)	2010-12-31	$76,833
Value of certain deemed distributions of participant loans	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN

2022: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	This submission is the final filing	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	This submission is the final filing	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	This submission is the final filing	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS 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	No
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 – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2010: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2008: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	No
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan funding arrangement – Trust	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement - Trust	Yes
2007: MN HEAD & NECK PAIN CLINIC 401(K) SAVINGS PLAN 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	No
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	No
2007-01-01	Plan funding arrangement – Trust	Yes
2007-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-829552

Policy instance

Insurance contract or identification number	GA-829552
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $2,627
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
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,627
Amount paid for insurance broker fees	0
Insurance broker name	FINTEGRA LLC

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-829552

Policy instance

Insurance contract or identification number	GA-829552
Number of Individuals Covered	31
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,670
Total amount of fees paid to insurance company	USD $614
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?	Yes
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	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,670
Insurance broker organization code?	3
Amount paid for insurance broker fees	614
Additional information about fees paid to insurance broker	SALES/ADMINISTRATION
Insurance broker name	JULY BUSINESS SERVICES

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-809360

Policy instance

Insurance contract or identification number	GA-809360
Number of Individuals Covered	34
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,310
Total amount of fees paid to insurance company	USD $390
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?	Yes
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	No
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,310
Insurance broker organization code?	4
Amount paid for insurance broker fees	390
Additional information about fees paid to insurance broker	SALES & ADMINISTRATION
Insurance broker name	JULY BUSINESS SERVICES

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Company Name:	MINNESOTA HEAD & NECK PAIN CLINIC, P.A.
Employer identification number (EIN):	411526541
NAIC Classification:	621112
NAIC Description:	Offices of Physicians, Mental Health Specialists