401k Plan data: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN plan

PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN
Plan identification number	002

PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA has sponsored the creation of one or more 401k plans.

Company Name: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA

Employer identification number (EIN): 571023276

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2017-01-01 MICHAEL DRAKEFORD 2018-10-04 MICHAEL DRAKEFORD 2018-10-04
002 2016-01-01 MICHAEL DRAKEFORD 2017-10-13 MICHAEL DRAKEFORD 2017-10-13
002 2015-01-01 MICHAEL DRAKEFORD MICHAEL DRAKEFORD 2016-10-14
002 2014-01-01 MICHAEL DRAKEFORD MICHAEL DRAKEFORD 2015-10-07
002 2013-01-01 MICHAEL DRAKEFORD MICHAEL DRAKEFORD 2014-10-14
002 2012-01-01 MICHAEL DRAKEFORD MICHAEL DRAKEFORD 2013-10-14
002 2011-01-01 MICHAEL DRAKEFORD MICHAEL DRAKEFORD 2013-10-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2017-01-01	MICHAEL DRAKEFORD	2018-10-04	MICHAEL DRAKEFORD	2018-10-04
002	2016-01-01	MICHAEL DRAKEFORD	2017-10-13	MICHAEL DRAKEFORD	2017-10-13
002	2015-01-01	MICHAEL DRAKEFORD		MICHAEL DRAKEFORD	2016-10-14
002	2014-01-01	MICHAEL DRAKEFORD		MICHAEL DRAKEFORD	2015-10-07
002	2013-01-01	MICHAEL DRAKEFORD		MICHAEL DRAKEFORD	2014-10-14
002	2012-01-01	MICHAEL DRAKEFORD		MICHAEL DRAKEFORD	2013-10-14
002	2011-01-01	MICHAEL DRAKEFORD		MICHAEL DRAKEFORD	2013-10-14

Plan Statistics for PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN

Measure Date Value
2015: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 7
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 4
Total of all active and inactive participants 2015-01-01 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 11
Number of participants with account balances 2015-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 7
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 8
Total of all active and inactive participants 2014-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 15
Number of participants with account balances 2014-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 9
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 8
Total of all active and inactive participants 2013-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 17
Number of participants with account balances 2013-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 9
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 7
Total of all active and inactive participants 2012-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 16
Number of participants with account balances 2012-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 9
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 7
Total of all active and inactive participants 2011-01-01 16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 16
Number of participants with account balances 2011-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0

Measure	Date	Value
2015: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	7
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	4
Total of all active and inactive participants	2015-01-01	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	11
Number of participants with account balances	2015-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	7
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	8
Total of all active and inactive participants	2014-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	15
Number of participants with account balances	2014-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	9
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	8
Total of all active and inactive participants	2013-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	17
Number of participants with account balances	2013-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	9
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	7
Total of all active and inactive participants	2012-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	16
Number of participants with account balances	2012-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	9
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	7
Total of all active and inactive participants	2011-01-01	16
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	16
Number of participants with account balances	2011-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0

Financial Data on PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2015 : PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$19,581
Expenses. Total of all expenses incurred	2015-12-31	$41,088
Benefits paid (including direct rollovers)	2015-12-31	$36,822
Total plan assets at end of year	2015-12-31	$730,508
Total plan assets at beginning of year	2015-12-31	$752,015
Value of fidelity bond covering the plan	2015-12-31	$100,000
Total contributions received or receivable from participants	2015-12-31	$30,513
Expenses. Other expenses not covered elsewhere	2015-12-31	$0
Contributions received from other sources (not participants or employers)	2015-12-31	$0
Other income received	2015-12-31	$-16,297
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$-21,507
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$730,508
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$752,015
Total contributions received or receivable from employer(s)	2015-12-31	$5,365
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$4,266
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$44,775
Expenses. Total of all expenses incurred	2014-12-31	$39,955
Benefits paid (including direct rollovers)	2014-12-31	$32,629
Total plan assets at end of year	2014-12-31	$752,015
Total plan assets at beginning of year	2014-12-31	$747,195
Value of fidelity bond covering the plan	2014-12-31	$100,000
Total contributions received or receivable from participants	2014-12-31	$6,611
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$33,813
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$4,820
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$752,015
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$747,195
Total contributions received or receivable from employer(s)	2014-12-31	$4,351
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$7,326
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$110,094
Expenses. Total of all expenses incurred	2013-12-31	$35,562
Benefits paid (including direct rollovers)	2013-12-31	$30,043
Total plan assets at end of year	2013-12-31	$747,195
Total plan assets at beginning of year	2013-12-31	$672,663
Value of fidelity bond covering the plan	2013-12-31	$100,000
Total contributions received or receivable from participants	2013-12-31	$6,134
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$100,082
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$74,532
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$747,195
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$672,663
Total contributions received or receivable from employer(s)	2013-12-31	$3,878
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$5,519
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$67,626
Expenses. Total of all expenses incurred	2012-12-31	$8,735
Benefits paid (including direct rollovers)	2012-12-31	$4,000
Total plan assets at end of year	2012-12-31	$672,663
Total plan assets at beginning of year	2012-12-31	$613,772
Value of fidelity bond covering the plan	2012-12-31	$100,000
Total contributions received or receivable from participants	2012-12-31	$7,175
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$55,726
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$58,891
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$672,663
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$613,772
Total contributions received or receivable from employer(s)	2012-12-31	$4,725
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$4,735
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$13,478
Expenses. Total of all expenses incurred	2011-12-31	$21,099
Benefits paid (including direct rollovers)	2011-12-31	$16,674
Total plan assets at end of year	2011-12-31	$613,772
Total plan assets at beginning of year	2011-12-31	$621,393
Value of fidelity bond covering the plan	2011-12-31	$100,000
Total contributions received or receivable from participants	2011-12-31	$7,929
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$1,439
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-7,621
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$613,772
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$621,393
Total contributions received or receivable from employer(s)	2011-12-31	$4,110
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$4,425
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0

Form 5500 Responses for PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN

2015: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	Yes
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-804660

Policy instance

Insurance contract or identification number	GA-804660
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVISORS INS AGENCY

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

Policy contract number

GA-804660

Policy instance

Insurance contract or identification number	GA-804660
Number of Individuals Covered	15
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $465
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $465
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVISORS INS AGENCY

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

Policy contract number

GA-804660

Policy instance

Insurance contract or identification number	GA-804660
Number of Individuals Covered	14
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $465
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $465
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVISORS INS AGENCY

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

Policy contract number

GA-804660

Policy instance

Insurance contract or identification number	GA-804660
Number of Individuals Covered	14
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $465
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $465
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVISORS INS AGENCY

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

Policy contract number

GA-804660

Policy instance

Insurance contract or identification number	GA-804660
Number of Individuals Covered	9
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $465
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	PALMETTO ORTHOPAEDIC & SPORTS MEDICINE, PA
Employer identification number (EIN):	571023276
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)