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TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 401k Plan overview

Plan NameTAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC.
Plan identification number 002

TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

CAROLINA HEALTH CENTERS, INC has sponsored the creation of one or more 401k plans.

Company Name:CAROLINA HEALTH CENTERS, INC
Employer identification number (EIN):570650154
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022016-01-01KIMBERLY ANDERSON KIMBERLY ANDERSON2017-10-13
0022015-01-01
0022014-01-01PAUL GROGAN
0022013-01-01PAUL GROGAN
0022012-01-01PAUL GROGAN
0022011-01-01BRITTANY OWEN
0022010-01-01REGINALD MARTIN
0022009-01-01REGINALD MARTIN

Plan Statistics for TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC.

401k plan membership statisitcs for TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC.

Measure Date Value
2016: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2016 401k membership
Total participants, beginning-of-year2016-01-01327
Total number of active participants reported on line 7a of the Form 55002016-01-01347
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-011
Total of all active and inactive participants2016-01-01348
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-011
Total participants2016-01-01349
Number of participants with account balances2016-01-01241
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2015 401k membership
Total participants, beginning-of-year2015-01-01260
Total number of active participants reported on line 7a of the Form 55002015-01-01242
Number of retired or separated participants receiving benefits2015-01-011
Number of other retired or separated participants entitled to future benefits2015-01-0131
Total of all active and inactive participants2015-01-01274
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01274
Number of participants with account balances2015-01-01152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2014 401k membership
Total participants, beginning-of-year2014-01-01232
Total number of active participants reported on line 7a of the Form 55002014-01-01235
Number of retired or separated participants receiving benefits2014-01-011
Number of other retired or separated participants entitled to future benefits2014-01-0130
Total of all active and inactive participants2014-01-01266
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01266
Number of participants with account balances2014-01-01133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-012
2013: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2013 401k membership
Total participants, beginning-of-year2013-01-01216
Total number of active participants reported on line 7a of the Form 55002013-01-01223
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0110
Total of all active and inactive participants2013-01-01233
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01233
Number of participants with account balances2013-01-01104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-011
2012: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2012 401k membership
Total participants, beginning-of-year2012-01-01210
Total number of active participants reported on line 7a of the Form 55002012-01-01228
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01228
Total participants2012-01-01228
Number of participants with account balances2012-01-01114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2011 401k membership
Total participants, beginning-of-year2011-01-01192
Total number of active participants reported on line 7a of the Form 55002011-01-01190
Number of retired or separated participants receiving benefits2011-01-018
Number of other retired or separated participants entitled to future benefits2011-01-0119
Total of all active and inactive participants2011-01-01217
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01217
Number of participants with account balances2011-01-01113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2010 401k membership
Total participants, beginning-of-year2010-01-01184
Total number of active participants reported on line 7a of the Form 55002010-01-01176
Number of other retired or separated participants entitled to future benefits2010-01-0126
Total of all active and inactive participants2010-01-01202
Total participants2010-01-01202
Number of participants with account balances2010-01-01104
2009: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2009 401k membership
Total participants, beginning-of-year2009-01-01160
Total number of active participants reported on line 7a of the Form 55002009-01-01174
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0124
Total of all active and inactive participants2009-01-01198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01198
Number of participants with account balances2009-01-01101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC.

Measure Date Value
2016 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets2016-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$0
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total transfer of assets to this plan2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$1,313,834
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$196,445
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$194,737
Expenses. Certain deemed distributions of participant loans2016-12-31$0
Value of total corrective distributions2016-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$984,763
Value of total assets at end of year2016-12-31$6,115,539
Value of total assets at beginning of year2016-12-31$4,998,150
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$1,708
Total income from rents2016-12-31$0
Total interest from all sources2016-12-31$4,991
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$62,258
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$62,258
Administrative expenses professional fees incurred2016-12-31$0
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Amount of non-exempt transactions with any party-in-interest2016-12-31$0
Contributions received from participants2016-12-31$590,607
Participant contributions at end of year2016-12-31$57,548
Participant contributions at beginning of year2016-12-31$58,113
Participant contributions at end of year2016-12-31$21,340
Participant contributions at beginning of year2016-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$89,694
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$0
Other income not declared elsewhere2016-12-31$758
Administrative expenses (other) incurred2016-12-31$0
Liabilities. Value of operating payables at beginning of year2016-12-31$0
Total non interest bearing cash at end of year2016-12-31$0
Total non interest bearing cash at beginning of year2016-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$1,117,389
Value of net assets at end of year (total assets less liabilities)2016-12-31$6,115,539
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$4,998,150
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2016-12-31$0
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2016-12-31$0
Investment advisory and management fees2016-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$5,825,336
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$4,766,650
Interest on participant loans2016-12-31$2,768
Income. Interest from loans (other than to participants)2016-12-31$0
Interest earned on other investments2016-12-31$2,223
Income. Interest from US Government securities2016-12-31$0
Income. Interest from corporate debt instruments2016-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$204,926
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$173,387
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$261,064
Net investment gain/loss from pooled separate accounts2016-12-31$0
Net investment gain or loss from common/collective trusts2016-12-31$0
Net gain/loss from 103.12 investment entities2016-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31Yes
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$304,462
Employer contributions (assets) at end of year2016-12-31$6,389
Employer contributions (assets) at beginning of year2016-12-31$0
Income. Dividends from preferred stock2016-12-31$0
Income. Dividends from common stock2016-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$194,737
Contract administrator fees2016-12-31$1,708
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$0
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Aggregate proceeds on sale of assets2016-12-31$0
Aggregate carrying amount (costs) on sale of assets2016-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2016-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31ELLIOTT DAVIS, LLC
Accountancy firm EIN2016-12-31570381582
2015 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2015 401k financial data
Unrealized appreciation/depreciation of real estate assets2015-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$0
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total transfer of assets to this plan2015-12-31$0
Total transfer of assets from this plan2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$606,912
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$130,270
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$123,698
Expenses. Certain deemed distributions of participant loans2015-12-31$4,555
Value of total corrective distributions2015-12-31$579
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$573,904
Value of total assets at end of year2015-12-31$4,998,150
Value of total assets at beginning of year2015-12-31$4,521,508
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$1,438
Total income from rents2015-12-31$0
Total interest from all sources2015-12-31$3,117
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$47,219
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$47,219
Administrative expenses professional fees incurred2015-12-31$0
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$479,757
Participant contributions at end of year2015-12-31$58,113
Participant contributions at beginning of year2015-12-31$99,118
Participant contributions at end of year2015-12-31$0
Participant contributions at beginning of year2015-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$13,843
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-12-31$0
Other income not declared elsewhere2015-12-31$1,305
Administrative expenses (other) incurred2015-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$476,642
Value of net assets at end of year (total assets less liabilities)2015-12-31$4,998,150
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$4,521,508
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$4,766,650
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$4,350,930
Interest on participant loans2015-12-31$3,117
Income. Interest from loans (other than to participants)2015-12-31$0
Income. Interest from US Government securities2015-12-31$0
Income. Interest from corporate debt instruments2015-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$173,387
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$71,460
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-18,633
Net investment gain/loss from pooled separate accounts2015-12-31$0
Net investment gain or loss from common/collective trusts2015-12-31$0
Net gain/loss from 103.12 investment entities2015-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31Yes
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$80,304
Employer contributions (assets) at end of year2015-12-31$0
Employer contributions (assets) at beginning of year2015-12-31$0
Income. Dividends from preferred stock2015-12-31$0
Income. Dividends from common stock2015-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$123,698
Contract administrator fees2015-12-31$1,438
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Aggregate proceeds on sale of assets2015-12-31$0
Aggregate carrying amount (costs) on sale of assets2015-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31ELLIOTT DAVIS DECOSIMO, LLC
Accountancy firm EIN2015-12-31570381582
2014 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$759,331
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$1,100,307
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,093,436
Expenses. Certain deemed distributions of participant loans2014-12-31$5,763
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$455,710
Value of total assets at end of year2014-12-31$4,521,508
Value of total assets at beginning of year2014-12-31$4,862,484
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$1,108
Total interest from all sources2014-12-31$4,107
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$55,401
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$55,401
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$431,940
Participant contributions at end of year2014-12-31$99,118
Participant contributions at beginning of year2014-12-31$93,781
Participant contributions at end of year2014-12-31$0
Participant contributions at beginning of year2014-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$23,770
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-340,976
Value of net assets at end of year (total assets less liabilities)2014-12-31$4,521,508
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$4,862,484
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$4,350,930
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$4,696,054
Interest on participant loans2014-12-31$4,107
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$71,460
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$72,649
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$244,113
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31Yes
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Employer contributions (assets) at end of year2014-12-31$0
Employer contributions (assets) at beginning of year2014-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$1,093,436
Contract administrator fees2014-12-31$1,108
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31ELLIOTT DAVIS DECOSIMO, LLC
Accountancy firm EIN2014-12-31570381582
2013 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$1,331,941
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$437,400
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$432,866
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$581,369
Value of total assets at end of year2013-12-31$4,839,104
Value of total assets at beginning of year2013-12-31$3,944,563
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$4,534
Total interest from all sources2013-12-31$3,979
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$65,087
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$65,087
Administrative expenses professional fees incurred2013-12-31$3,179
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$465,856
Participant contributions at end of year2013-12-31$93,781
Participant contributions at beginning of year2013-12-31$71,455
Participant contributions at end of year2013-12-31$0
Participant contributions at beginning of year2013-12-31$18,026
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$32,180
Administrative expenses (other) incurred2013-12-31$405
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$894,541
Value of net assets at end of year (total assets less liabilities)2013-12-31$4,839,104
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$3,944,563
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$4,672,674
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$3,850,216
Interest on participant loans2013-12-31$3,343
Interest earned on other investments2013-12-31$636
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$72,649
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$681,506
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$83,333
Employer contributions (assets) at end of year2013-12-31$0
Employer contributions (assets) at beginning of year2013-12-31$4,866
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$432,866
Contract administrator fees2013-12-31$950
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31ELLIOTT DAVIS, LLC
Accountancy firm EIN2013-12-31570381582
2012 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$922,368
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$353,887
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$353,505
Expenses. Certain deemed distributions of participant loans2012-12-31$6,000
Value of total corrective distributions2012-12-31$14,876
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$568,991
Value of total assets at end of year2012-12-31$3,944,563
Value of total assets at beginning of year2012-12-31$3,376,082
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$382
Total interest from all sources2012-12-31$2,864
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$53,897
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$53,897
Administrative expenses professional fees incurred2012-12-31$382
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$418,143
Participant contributions at end of year2012-12-31$71,455
Participant contributions at beginning of year2012-12-31$59,554
Participant contributions at end of year2012-12-31$18,026
Participant contributions at beginning of year2012-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$34,793
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$568,481
Value of net assets at end of year (total assets less liabilities)2012-12-31$3,944,563
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$3,376,082
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$3,850,216
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$3,311,311
Value of interest in pooled separate accounts at end of year2012-12-31$0
Value of interest in pooled separate accounts at beginning of year2012-12-31$1,439
Interest on participant loans2012-12-31$2,800
Interest earned on other investments2012-12-31$64
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$40,361
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$296,616
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$116,055
Employer contributions (assets) at end of year2012-12-31$4,866
Employer contributions (assets) at beginning of year2012-12-31$5,217
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$353,505
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31Yes
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31ELLIOTT DAVIS, LLC
Accountancy firm EIN2012-12-31570381582
2011 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2011 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$166
Total income from all sources (including contributions)2011-12-31$367,347
Total of all expenses incurred2011-12-31$145,644
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$129,045
Value of total corrective distributions2011-12-31$15,720
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$450,849
Value of total assets at end of year2011-12-31$3,376,082
Value of total assets at beginning of year2011-12-31$3,154,545
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$879
Total interest from all sources2011-12-31$3,240
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$77,193
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$77,193
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$345,448
Participant contributions at end of year2011-12-31$59,554
Participant contributions at beginning of year2011-12-31$55,932
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$166
Administrative expenses (other) incurred2011-12-31$879
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$221,703
Value of net assets at end of year (total assets less liabilities)2011-12-31$3,376,082
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$3,154,379
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$3,311,311
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$3,086,195
Interest on participant loans2011-12-31$3,240
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$5,980
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-86,742
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$105,401
Employer contributions (assets) at end of year2011-12-31$5,217
Employer contributions (assets) at beginning of year2011-12-31$6,438
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$129,045
Contract administrator fees2011-12-31$21,066
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31ELLIOTT DAVIS, LLC
Accountancy firm EIN2011-12-31570381582
2010 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$166
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$41
Total income from all sources (including contributions)2010-12-31$755,606
Total of all expenses incurred2010-12-31$95,906
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$89,914
Value of total corrective distributions2010-12-31$4,862
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$446,201
Value of total assets at end of year2010-12-31$3,154,545
Value of total assets at beginning of year2010-12-31$2,513,883
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$1,130
Total interest from all sources2010-12-31$3,189
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$300,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$328,195
Participant contributions at end of year2010-12-31$55,932
Participant contributions at beginning of year2010-12-31$66,439
Participant contributions at beginning of year2010-12-31$21,969
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$21,442
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$166
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$41
Administrative expenses (other) incurred2010-12-31$1,130
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$659,700
Value of net assets at end of year (total assets less liabilities)2010-12-31$3,154,379
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$2,513,842
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$3,086,195
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$2,414,878
Interest on participant loans2010-12-31$3,189
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$5,980
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$4,541
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$306,216
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31Yes
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$96,564
Employer contributions (assets) at end of year2010-12-31$6,438
Employer contributions (assets) at beginning of year2010-12-31$6,056
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$89,914
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31ELLIOTT DAVIS LLC
Accountancy firm EIN2010-12-31510381582
2009 : TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC.

2016: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedYes
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: TAX DEFERRED ANNUITY PLAN FOR EMPLOYEES OF CAROLINA HEALTH CENTERS,INC. 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered241
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $188
Total amount of fees paid to insurance companyUSD $44
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $188
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameRETIREMENT STRATEGIES CORP
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered225
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $185
Total amount of fees paid to insurance companyUSD $42
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $185
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameRETIREMENT STRATEGIES CORP
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered225
Insurance policy start date2013-06-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,425
Total amount of fees paid to insurance companyUSD $4,146
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,425
Amount paid for insurance broker fees1900
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker organization code?3
Insurance broker nameRETIREMENT STRATEGIES CORP
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered222
Insurance policy start date2012-06-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $39,481
Total amount of fees paid to insurance companyUSD $2,479
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 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?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,481
Insurance broker organization code?3
Amount paid for insurance broker fees2479
Additional information about fees paid to insurance brokerREFERRAL/SERVICE FEE
Insurance broker nameRETIREMENT STRATEGIES CORP
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCAROLI09
Policy instance 1
Insurance contract or identification numberCAROLI09
Number of Individuals Covered217
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $36
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCAROLI09
Policy instance 1
Insurance contract or identification numberCAROLI09
Number of Individuals Covered202
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $87
Total amount of fees paid to insurance companyUSD $0
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 guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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