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MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 401k Plan overview

Plan NameMEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN
Plan identification number 001

MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT 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.
  • 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.
  • Life insurance

401k Sponsoring company profile

MEDICAL X-RAY CENTER, P.C. has sponsored the creation of one or more 401k plans.

Company Name:MEDICAL X-RAY CENTER, P.C.
Employer identification number (EIN):460340989
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012012-03-01DR. BRAD PAULSON DR. BRAD PAULSON2013-04-03
0012011-06-01DR. EDWARD CZARNECKI DR. EDWARD CZARNECKI2012-12-13
0012010-06-01GERALD LARSON GERALD LARSON2012-03-15
0012009-06-01GERALD LARSON GERALD LARSON2011-03-14

Plan Statistics for MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN

401k plan membership statisitcs for MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN

Measure Date Value
2012: MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-03-01122
Total number of active participants reported on line 7a of the Form 55002012-03-010
Number of retired or separated participants receiving benefits2012-03-010
Number of other retired or separated participants entitled to future benefits2012-03-010
Total of all active and inactive participants2012-03-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-03-010
Total participants2012-03-010
Number of participants with account balances2012-03-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-03-010
2011: MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01147
Total number of active participants reported on line 7a of the Form 55002011-06-012
Number of retired or separated participants receiving benefits2011-06-0118
Number of other retired or separated participants entitled to future benefits2011-06-01102
Total of all active and inactive participants2011-06-01122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-06-010
Total participants2011-06-01122
Number of participants with account balances2011-06-01122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-06-010
2010: MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-06-01146
Total number of active participants reported on line 7a of the Form 55002010-06-0169
Number of retired or separated participants receiving benefits2010-06-017
Number of other retired or separated participants entitled to future benefits2010-06-0171
Total of all active and inactive participants2010-06-01147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-06-010
Total participants2010-06-01147
Number of participants with account balances2010-06-01147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-06-010
2009: MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01136
Total number of active participants reported on line 7a of the Form 55002009-06-01114
Number of retired or separated participants receiving benefits2009-06-018
Number of other retired or separated participants entitled to future benefits2009-06-0121
Total of all active and inactive participants2009-06-01143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-06-010
Total participants2009-06-01143
Number of participants with account balances2009-06-01143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-06-010

Financial Data on MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN

Measure Date Value
2012 : MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-09-28$1,682
Total unrealized appreciation/depreciation of assets2012-09-28$1,682
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-28$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-28$0
Total income from all sources (including contributions)2012-09-28$-229,637
Total loss/gain on sale of assets2012-09-28$0
Total of all expenses incurred2012-09-28$44,837,142
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-09-28$44,837,142
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-09-28$0
Value of total assets at end of year2012-09-28$0
Value of total assets at beginning of year2012-09-28$45,066,779
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-09-28$0
Total interest from all sources2012-09-28$39
Total dividends received (eg from common stock, registered investment company shares)2012-09-28$227,800
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-09-28Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2012-09-28$0
Total dividends received from registered investment company shares (eg mutual funds)2012-09-28$227,800
Assets. Corporate prefeered stocks other than exployer securities at end of year2012-09-28$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2012-09-28$537,109
Was this plan covered by a fidelity bond2012-09-28Yes
Value of fidelity bond cover2012-09-28$500,000
If this is an individual account plan, was there a blackout period2012-09-28No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-09-28$0
Were there any nonexempt tranactions with any party-in-interest2012-09-28No
Participant contributions at end of year2012-09-28$0
Participant contributions at beginning of year2012-09-28$41,577
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-09-28$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-09-28$27,209
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-28No
Value of net income/loss2012-09-28$-45,066,779
Value of net assets at end of year (total assets less liabilities)2012-09-28$0
Value of net assets at beginning of year (total assets less liabilities)2012-09-28$45,066,779
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-09-28No
Were any loans by the plan or fixed income obligations due to the plan in default2012-09-28No
Were any leases to which the plan was party in default or uncollectible2012-09-28No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-09-28$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-09-28$29,489,722
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-09-28$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-09-28$10,166,316
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-09-28$10,166,316
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-09-28$39
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-09-28$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-09-28$294,266
Asset value of US Government securities at end of year2012-09-28$0
Asset value of US Government securities at beginning of year2012-09-28$39,992
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-09-28$-459,158
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-09-28No
Was there a failure to transmit to the plan any participant contributions2012-09-28No
Has the plan failed to provide any benefit when due under the plan2012-09-28No
Employer contributions (assets) at end of year2012-09-28$0
Employer contributions (assets) at beginning of year2012-09-28$779,838
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-09-28$44,837,142
Asset. Corporate debt instrument debt (other) at end of year2012-09-28$0
Asset. Corporate debt instrument debt (other) at beginning of year2012-09-28$2,144,668
Assets. Corporate common stocks other than exployer securities at end of year2012-09-28$0
Assets. Corporate common stocks other than exployer securities at beginning of year2012-09-28$1,546,082
Did the plan have assets held for investment2012-09-28No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-28No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-09-28Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-09-28Yes
Opinion of an independent qualified public accountant for this plan2012-09-28Disclaimer
Accountancy firm name2012-09-28MCGLADREY & PULLEN
Accountancy firm EIN2012-09-28420714325
Unrealized appreciation/depreciation of other (non real estate) assets2012-02-29$-13,139
Total unrealized appreciation/depreciation of assets2012-02-29$-13,139
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-02-29$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-02-29$32,516
Total income from all sources (including contributions)2012-02-29$458,593
Total loss/gain on sale of assets2012-02-29$0
Total of all expenses incurred2012-02-29$10,552,075
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-02-29$10,552,075
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-02-29$1,421,827
Value of total assets at end of year2012-02-29$45,066,779
Value of total assets at beginning of year2012-02-29$55,192,777
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-02-29$0
Total interest from all sources2012-02-29$3,887
Total dividends received (eg from common stock, registered investment company shares)2012-02-29$870,481
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-02-29Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2012-02-29$0
Total dividends received from registered investment company shares (eg mutual funds)2012-02-29$870,481
Assets. Corporate prefeered stocks other than exployer securities at end of year2012-02-29$537,109
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2012-02-29$390,852
Was this plan covered by a fidelity bond2012-02-29Yes
Value of fidelity bond cover2012-02-29$500,000
If this is an individual account plan, was there a blackout period2012-02-29No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-02-29$0
Were there any nonexempt tranactions with any party-in-interest2012-02-29No
Contributions received from participants2012-02-29$641,989
Participant contributions at end of year2012-02-29$41,577
Participant contributions at beginning of year2012-02-29$158,438
Participant contributions at end of year2012-02-29$0
Participant contributions at beginning of year2012-02-29$15,318
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-02-29$27,209
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-02-29$22,856
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-02-29No
Value of net income/loss2012-02-29$-10,093,482
Value of net assets at end of year (total assets less liabilities)2012-02-29$45,066,779
Value of net assets at beginning of year (total assets less liabilities)2012-02-29$55,160,261
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-02-29No
Were any loans by the plan or fixed income obligations due to the plan in default2012-02-29No
Were any leases to which the plan was party in default or uncollectible2012-02-29No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-02-29$29,489,722
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-02-29$35,797,427
Interest on participant loans2012-02-29$3,851
Value of interest in common/collective trusts at end of year2012-02-29$0
Value of interest in common/collective trusts at beginning of year2012-02-29$13,099,411
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-02-29$10,166,316
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-02-29$444,772
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-02-29$444,772
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-02-29$36
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-02-29$294,266
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-02-29$377,469
Asset value of US Government securities at end of year2012-02-29$39,992
Asset value of US Government securities at beginning of year2012-02-29$43,482
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-02-29$-1,568,433
Net investment gain or loss from common/collective trusts2012-02-29$-256,030
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-02-29No
Was there a failure to transmit to the plan any participant contributions2012-02-29No
Has the plan failed to provide any benefit when due under the plan2012-02-29No
Contributions received in cash from employer2012-02-29$779,838
Employer contributions (assets) at end of year2012-02-29$779,838
Employer contributions (assets) at beginning of year2012-02-29$1,701,540
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-02-29$10,552,075
Asset. Corporate debt instrument debt (other) at end of year2012-02-29$2,144,668
Asset. Corporate debt instrument debt (other) at beginning of year2012-02-29$1,979,913
Assets. Corporate common stocks other than exployer securities at end of year2012-02-29$1,546,082
Assets. Corporate common stocks other than exployer securities at beginning of year2012-02-29$1,161,299
Liabilities. Value of benefit claims payable at end of year2012-02-29$0
Liabilities. Value of benefit claims payable at beginning of year2012-02-29$32,516
Did the plan have assets held for investment2012-02-29Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-02-29No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-02-29No
2011 : MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-05-31$288,532
Total unrealized appreciation/depreciation of assets2011-05-31$288,532
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-05-31$32,516
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-05-31$0
Total income from all sources (including contributions)2011-05-31$11,133,299
Total loss/gain on sale of assets2011-05-31$0
Total of all expenses incurred2011-05-31$192,834
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-05-31$192,834
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-05-31$2,585,929
Value of total assets at end of year2011-05-31$55,192,777
Value of total assets at beginning of year2011-05-31$44,219,796
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-05-31$0
Total interest from all sources2011-05-31$7,752
Total dividends received (eg from common stock, registered investment company shares)2011-05-31$1,009,968
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-05-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-05-31$1,009,968
Assets. Corporate prefeered stocks other than exployer securities at end of year2011-05-31$390,852
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2011-05-31$237,421
Was this plan covered by a fidelity bond2011-05-31Yes
Value of fidelity bond cover2011-05-31$500,000
If this is an individual account plan, was there a blackout period2011-05-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-05-31$0
Were there any nonexempt tranactions with any party-in-interest2011-05-31No
Contributions received from participants2011-05-31$881,177
Participant contributions at end of year2011-05-31$158,438
Participant contributions at beginning of year2011-05-31$151,392
Participant contributions at end of year2011-05-31$15,318
Participant contributions at beginning of year2011-05-31$0
Income. Received or receivable in cash from other sources (including rollovers)2011-05-31$3,212
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-05-31$22,856
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-05-31$10,954
Other income not declared elsewhere2011-05-31$333,678
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Value of net income/loss2011-05-31$10,940,465
Value of net assets at end of year (total assets less liabilities)2011-05-31$55,160,261
Value of net assets at beginning of year (total assets less liabilities)2011-05-31$44,219,796
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-05-31No
Were any leases to which the plan was party in default or uncollectible2011-05-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-05-31$35,797,427
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-05-31$28,111,539
Interest on participant loans2011-05-31$7,737
Value of interest in common/collective trusts at end of year2011-05-31$13,099,411
Value of interest in common/collective trusts at beginning of year2011-05-31$11,473,154
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-05-31$444,772
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-05-31$244,861
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-05-31$244,861
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-05-31$15
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-05-31$377,469
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-05-31$166,563
Expenses. Payments to insurance carriers foe the provision of benefits2011-05-31$1,266
Asset value of US Government securities at end of year2011-05-31$43,482
Asset value of US Government securities at beginning of year2011-05-31$39,689
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-05-31$5,922,846
Net investment gain or loss from common/collective trusts2011-05-31$984,594
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-05-31No
Was there a failure to transmit to the plan any participant contributions2011-05-31No
Has the plan failed to provide any benefit when due under the plan2011-05-31No
Contributions received in cash from employer2011-05-31$1,701,540
Employer contributions (assets) at end of year2011-05-31$1,701,540
Employer contributions (assets) at beginning of year2011-05-31$1,585,580
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-05-31$191,568
Asset. Corporate debt instrument debt (other) at end of year2011-05-31$1,979,913
Asset. Corporate debt instrument debt (other) at beginning of year2011-05-31$1,572,342
Assets. Corporate common stocks other than exployer securities at end of year2011-05-31$1,161,299
Assets. Corporate common stocks other than exployer securities at beginning of year2011-05-31$626,301
Liabilities. Value of benefit claims payable at end of year2011-05-31$32,516
Did the plan have assets held for investment2011-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-05-31Yes
Opinion of an independent qualified public accountant for this plan2011-05-31Disclaimer
Accountancy firm name2011-05-31MCGLADREY & PULLEN
Accountancy firm EIN2011-05-31420714325
2010 : MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-05-31$0

Form 5500 Responses for MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN

2012: MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 2012 form 5500 responses
2012-03-01Type of plan entitySingle employer plan
2012-03-01Submission has been amendedNo
2012-03-01This submission is the final filingYes
2012-03-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-03-01Plan is a collectively bargained planNo
2012-03-01Plan funding arrangement – InsuranceYes
2012-03-01Plan funding arrangement – TrustYes
2012-03-01Plan benefit arrangement – InsuranceYes
2012-03-01Plan benefit arrangement - TrustYes
2011: MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)Yes
2011-06-01Plan is a collectively bargained planNo
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan funding arrangement – TrustYes
2011-06-01Plan benefit arrangement – InsuranceYes
2011-06-01Plan benefit arrangement - TrustYes
2010: MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 2010 form 5500 responses
2010-06-01Type of plan entitySingle employer plan
2010-06-01Submission has been amendedNo
2010-06-01This submission is the final filingNo
2010-06-01This return/report is a short plan year return/report (less than 12 months)No
2010-06-01Plan is a collectively bargained planNo
2010-06-01Plan funding arrangement – InsuranceYes
2010-06-01Plan funding arrangement – TrustYes
2010-06-01Plan benefit arrangement – InsuranceYes
2010-06-01Plan benefit arrangement - TrustYes
2009: MEDICAL X-RAY CENTER, P.C. 401(K) RETIREMENT PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Submission has been amendedNo
2009-06-01This submission is the final filingNo
2009-06-01This return/report is a short plan year return/report (less than 12 months)No
2009-06-01Plan is a collectively bargained planNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan funding arrangement – TrustYes
2009-06-01Plan benefit arrangement – InsuranceYes
2009-06-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63665 )
Policy contract number16045
Policy instance 2
Insurance contract or identification number16045
Number of Individuals Covered0
Insurance policy start date2012-03-01
Insurance policy end date2012-09-28
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number55673
Policy instance 1
Insurance contract or identification number55673
Number of Individuals Covered0
Insurance policy start date2012-03-01
Insurance policy end date2012-09-28
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63665 )
Policy contract number16045
Policy instance 1
Insurance contract or identification number16045
Number of Individuals Covered1
Insurance policy start date2011-06-01
Insurance policy end date2012-02-29
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number55673
Policy instance 2
Insurance contract or identification number55673
Number of Individuals Covered1
Insurance policy start date2011-06-01
Insurance policy end date2012-02-29
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63665 )
Policy contract number16045
Policy instance 1
Insurance contract or identification number16045
Number of Individuals Covered1
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GENWORTH LIFE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 63401 )
Policy contract number457245
Policy instance 2
Insurance contract or identification number457245
Number of Individuals Covered0
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 )
Policy contract number55673
Policy instance 3
Insurance contract or identification number55673
Number of Individuals Covered1
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number2559758
Policy instance 4
Insurance contract or identification number2559758
Number of Individuals Covered0
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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