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DENTISTRY FOR CHILDREN & ADOLESCENTS, PC PROFIT SHARING PLAN 401k Plan overview

Plan NameDENTISTRY FOR CHILDREN & ADOLESCENTS, PC PROFIT SHARING PLAN
Plan identification number 003

DENTISTRY FOR CHILDREN & ADOLESCENTS, PC PROFIT SHARING PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    DENTISTRY FOR CHILDREN & ADOLESCENTS, P.C. has sponsored the creation of one or more 401k plans.

    Company Name:DENTISTRY FOR CHILDREN & ADOLESCENTS, P.C.
    Employer identification number (EIN):581086490
    NAIC Classification:621210
    NAIC Description:Offices of Dentists

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan DENTISTRY FOR CHILDREN & ADOLESCENTS, PC PROFIT SHARING PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    0032021-01-01
    0032020-01-01
    0032019-01-01
    0032017-01-01BRYAN LOBEL
    0032016-01-01BRYAN LOBEL
    0032015-01-01BRYAN LOBEL
    0032014-01-01BRYAN LOBEL BRYAN LOBEL2015-09-21
    0032013-01-01BRYAN LOBEL BRYAN LOBEL2014-09-15
    0032012-01-01BRYAN LOBEL BRYAN LOBEL2013-10-08
    0032011-01-01BRYAN LOBEL BRYAN LOBEL2012-09-24
    0032010-01-01BRYAN LOBEL BRYAN LOBEL2011-10-11
    0032009-01-01BRYAN LOBEL

    Plan Statistics for DENTISTRY FOR CHILDREN & ADOLESCENTS, PC PROFIT SHARING PLAN

    401k plan membership statisitcs for DENTISTRY FOR CHILDREN & ADOLESCENTS, PC PROFIT SHARING PLAN

    Measure Date Value
    2021
    Total participants, beginning-of-year2021-01-0144
    Total number of active participants reported on line 7a of the Form 55002021-01-0124
    Number of retired or separated participants receiving benefits2021-01-010
    Number of other retired or separated participants entitled to future benefits2021-01-0121
    Total of all active and inactive participants2021-01-0145
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
    Total participants2021-01-0145
    Number of participants with account balances2021-01-0145
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-018
    2020
    Total participants, beginning-of-year2020-01-0143
    Total number of active participants reported on line 7a of the Form 55002020-01-0127
    Number of retired or separated participants receiving benefits2020-01-010
    Number of other retired or separated participants entitled to future benefits2020-01-0112
    Total of all active and inactive participants2020-01-0139
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
    Total participants2020-01-0139
    Number of participants with account balances2020-01-0139
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-012
    2019
    Total participants, beginning-of-year2019-01-0143
    Total number of active participants reported on line 7a of the Form 55002019-01-0125
    Number of retired or separated participants receiving benefits2019-01-010
    Number of other retired or separated participants entitled to future benefits2019-01-0115
    Total of all active and inactive participants2019-01-0140
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
    Total participants2019-01-0140
    Number of participants with account balances2019-01-0140
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-017
    2017
    Total participants, beginning-of-year2017-01-0145
    Total number of active participants reported on line 7a of the Form 55002017-01-0126
    Number of retired or separated participants receiving benefits2017-01-013
    Number of other retired or separated participants entitled to future benefits2017-01-0111
    Total of all active and inactive participants2017-01-0140
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
    Total participants2017-01-0140
    Number of participants with account balances2017-01-0140
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-013
    2016
    Total participants, beginning-of-year2016-01-0143
    Total number of active participants reported on line 7a of the Form 55002016-01-0124
    Number of retired or separated participants receiving benefits2016-01-010
    Number of other retired or separated participants entitled to future benefits2016-01-0115
    Total of all active and inactive participants2016-01-0139
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-011
    Total participants2016-01-0140
    Number of participants with account balances2016-01-0140
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-013
    2015
    Total participants, beginning-of-year2015-01-0142
    Total number of active participants reported on line 7a of the Form 55002015-01-0132
    Number of retired or separated participants receiving benefits2015-01-010
    Number of other retired or separated participants entitled to future benefits2015-01-0110
    Total of all active and inactive participants2015-01-0142
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
    Total participants2015-01-0142
    Number of participants with account balances2015-01-0142
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-013
    2014
    Total participants, beginning-of-year2014-01-0132
    Total number of active participants reported on line 7a of the Form 55002014-01-0132
    Number of retired or separated participants receiving benefits2014-01-012
    Number of other retired or separated participants entitled to future benefits2014-01-016
    Total of all active and inactive participants2014-01-0140
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
    Total participants2014-01-0140
    Number of participants with account balances2014-01-0140
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-012
    2013
    Total participants, beginning-of-year2013-01-0145
    Total number of active participants reported on line 7a of the Form 55002013-01-0131
    Number of retired or separated participants receiving benefits2013-01-014
    Number of other retired or separated participants entitled to future benefits2013-01-016
    Total of all active and inactive participants2013-01-0141
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
    Total participants2013-01-0141
    Number of participants with account balances2013-01-0141
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-015
    2012
    Total participants, beginning-of-year2012-01-0141
    Total number of active participants reported on line 7a of the Form 55002012-01-0130
    Number of retired or separated participants receiving benefits2012-01-015
    Number of other retired or separated participants entitled to future benefits2012-01-015
    Total of all active and inactive participants2012-01-0140
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
    Total participants2012-01-0140
    Number of participants with account balances2012-01-0140
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
    2011
    Total participants, beginning-of-year2011-01-0143
    Total number of active participants reported on line 7a of the Form 55002011-01-0127
    Number of retired or separated participants receiving benefits2011-01-010
    Number of other retired or separated participants entitled to future benefits2011-01-0111
    Total of all active and inactive participants2011-01-0138
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
    Total participants2011-01-0138
    Number of participants with account balances2011-01-0138
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-013
    2010
    Total participants, beginning-of-year2010-01-0142
    Total number of active participants reported on line 7a of the Form 55002010-01-0128
    Number of retired or separated participants receiving benefits2010-01-010
    Number of other retired or separated participants entitled to future benefits2010-01-0112
    Total of all active and inactive participants2010-01-0140
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
    Total participants2010-01-0140
    Number of participants with account balances2010-01-0140
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-011
    2009
    Total participants, beginning-of-year2009-01-0141
    Total number of active participants reported on line 7a of the Form 55002009-01-0130
    Number of retired or separated participants receiving benefits2009-01-010
    Number of other retired or separated participants entitled to future benefits2009-01-0111
    Total of all active and inactive participants2009-01-0141
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
    Total participants2009-01-0141
    Number of participants with account balances2009-01-0141
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-011

    Financial Data on DENTISTRY FOR CHILDREN & ADOLESCENTS, PC PROFIT SHARING PLAN

    Measure Date Value
    2021
    Total income from all sources2021-12-31$584,287
    Expenses. Total of all expenses incurred2021-12-31$145,778
    Benefits paid (including direct rollovers)2021-12-31$145,428
    Total plan assets at end of year2021-12-31$4,561,301
    Total plan assets at beginning of year2021-12-31$4,122,792
    Value of fidelity bond covering the plan2021-12-31$500,000
    Total contributions received or receivable from participants2021-12-31$120,238
    Other income received2021-12-31$291,478
    Net income (gross income less expenses)2021-12-31$438,509
    Net plan assets at end of year (total assets less liabilities)2021-12-31$4,561,301
    Net plan assets at beginning of year (total assets less liabilities)2021-12-31$4,122,792
    Assets. Value of assets in partnership/joint-venture interests2021-12-31$46,578
    Total contributions received or receivable from employer(s)2021-12-31$172,571
    Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$350
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
    2020
    Total income from all sources2020-12-31$296,186
    Expenses. Total of all expenses incurred2020-12-31$991,172
    Benefits paid (including direct rollovers)2020-12-31$983,248
    Total plan assets at end of year2020-12-31$4,122,792
    Total plan assets at beginning of year2020-12-31$4,817,778
    Value of fidelity bond covering the plan2020-12-31$500,000
    Total contributions received or receivable from participants2020-12-31$102,552
    Other income received2020-12-31$28,645
    Net income (gross income less expenses)2020-12-31$-694,986
    Net plan assets at end of year (total assets less liabilities)2020-12-31$4,122,792
    Net plan assets at beginning of year (total assets less liabilities)2020-12-31$4,817,778
    Assets. Value of assets in partnership/joint-venture interests2020-12-31$226,766
    Total contributions received or receivable from employer(s)2020-12-31$164,989
    Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$7,924
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
    2019
    Total income from all sources2019-12-31$933,376
    Expenses. Total of all expenses incurred2019-12-31$293,358
    Benefits paid (including direct rollovers)2019-12-31$283,933
    Total plan assets at end of year2019-12-31$4,817,778
    Total plan assets at beginning of year2019-12-31$4,177,760
    Value of fidelity bond covering the plan2019-12-31$1,021,700
    Total contributions received or receivable from participants2019-12-31$102,687
    Other income received2019-12-31$680,698
    Net income (gross income less expenses)2019-12-31$640,018
    Net plan assets at end of year (total assets less liabilities)2019-12-31$4,817,778
    Net plan assets at beginning of year (total assets less liabilities)2019-12-31$4,177,760
    Assets. Value of assets in partnership/joint-venture interests2019-12-31$599,889
    Total contributions received or receivable from employer(s)2019-12-31$149,991
    Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$9,425
    2018
    Total income from all sources2018-12-31$170,102
    Expenses. Total of all expenses incurred2018-12-31$91,358
    Benefits paid (including direct rollovers)2018-12-31$86,395
    Total plan assets at end of year2018-12-31$4,177,760
    Total plan assets at beginning of year2018-12-31$4,099,016
    Value of fidelity bond covering the plan2018-12-31$1,074,000
    Total contributions received or receivable from participants2018-12-31$89,514
    Other income received2018-12-31$-73,736
    Net income (gross income less expenses)2018-12-31$78,744
    Net plan assets at end of year (total assets less liabilities)2018-12-31$4,177,760
    Net plan assets at beginning of year (total assets less liabilities)2018-12-31$4,099,016
    Assets. Value of assets in partnership/joint-venture interests2018-12-31$663,256
    Total contributions received or receivable from employer(s)2018-12-31$154,324
    Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$4,963
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
    2017
    Total income from all sources2017-12-31$971,759
    Expenses. Total of all expenses incurred2017-12-31$2,018,893
    Benefits paid (including direct rollovers)2017-12-31$2,015,843
    Total plan assets at end of year2017-12-31$4,099,016
    Total plan assets at beginning of year2017-12-31$5,146,150
    Value of fidelity bond covering the plan2017-12-31$925,000
    Total contributions received or receivable from participants2017-12-31$61,104
    Other income received2017-12-31$729,655
    Net income (gross income less expenses)2017-12-31$-1,047,134
    Net plan assets at end of year (total assets less liabilities)2017-12-31$4,099,016
    Net plan assets at beginning of year (total assets less liabilities)2017-12-31$5,146,150
    Assets. Value of assets in partnership/joint-venture interests2017-12-31$467,695
    Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022017-12-31$1,479
    Total contributions received or receivable from employer(s)2017-12-31$181,000
    Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$3,050
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
    2016
    Total income from all sources2016-12-31$447,890
    Expenses. Total of all expenses incurred2016-12-31$315,074
    Benefits paid (including direct rollovers)2016-12-31$313,634
    Total plan assets at end of year2016-12-31$5,146,150
    Total plan assets at beginning of year2016-12-31$5,013,334
    Value of fidelity bond covering the plan2016-12-31$925,000
    Total contributions received or receivable from participants2016-12-31$104,377
    Contributions received from other sources (not participants or employers)2016-12-31$0
    Other income received2016-12-31$162,003
    Net income (gross income less expenses)2016-12-31$132,816
    Net plan assets at end of year (total assets less liabilities)2016-12-31$5,146,150
    Net plan assets at beginning of year (total assets less liabilities)2016-12-31$5,013,334
    Assets. Value of assets in partnership/joint-venture interests2016-12-31$332,629
    Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022016-12-31$3,434
    Total contributions received or receivable from employer(s)2016-12-31$181,510
    Value of certain deemed distributions of participant loans2016-12-31$1,440
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
    2015
    Total income from all sources2015-12-31$377,193
    Expenses. Total of all expenses incurred2015-12-31$83,043
    Benefits paid (including direct rollovers)2015-12-31$82,883
    Total plan assets at end of year2015-12-31$5,013,334
    Total plan assets at beginning of year2015-12-31$4,719,184
    Value of fidelity bond covering the plan2015-12-31$925,000
    Total contributions received or receivable from participants2015-12-31$115,115
    Contributions received from other sources (not participants or employers)2015-12-31$0
    Other income received2015-12-31$75,078
    Net income (gross income less expenses)2015-12-31$294,150
    Net plan assets at end of year (total assets less liabilities)2015-12-31$5,013,334
    Net plan assets at beginning of year (total assets less liabilities)2015-12-31$4,719,184
    Assets. Value of assets in partnership/joint-venture interests2015-12-31$447,170
    Total contributions received or receivable from employer(s)2015-12-31$187,000
    Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$160
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
    2014
    Total income from all sources2014-12-31$427,659
    Expenses. Total of all expenses incurred2014-12-31$192,583
    Benefits paid (including direct rollovers)2014-12-31$192,343
    Total plan assets at end of year2014-12-31$4,719,184
    Total plan assets at beginning of year2014-12-31$4,484,108
    Value of fidelity bond covering the plan2014-12-31$650,000
    Total contributions received or receivable from participants2014-12-31$112,860
    Other income received2014-12-31$136,427
    Net income (gross income less expenses)2014-12-31$235,076
    Net plan assets at end of year (total assets less liabilities)2014-12-31$4,719,184
    Net plan assets at beginning of year (total assets less liabilities)2014-12-31$4,484,108
    Assets. Value of assets in partnership/joint-venture interests2014-12-31$427,165
    Total contributions received or receivable from employer(s)2014-12-31$178,372
    Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$240
    2013
    Total income from all sources2013-12-31$595,850
    Expenses. Total of all expenses incurred2013-12-31$155,316
    Benefits paid (including direct rollovers)2013-12-31$153,851
    Total plan assets at end of year2013-12-31$4,484,108
    Total plan assets at beginning of year2013-12-31$4,043,574
    Value of fidelity bond covering the plan2013-12-31$650,000
    Total contributions received or receivable from participants2013-12-31$111,885
    Other income received2013-12-31$307,714
    Net income (gross income less expenses)2013-12-31$440,534
    Net plan assets at end of year (total assets less liabilities)2013-12-31$4,484,108
    Net plan assets at beginning of year (total assets less liabilities)2013-12-31$4,043,574
    Assets. Value of assets in partnership/joint-venture interests2013-12-31$272,862
    Total contributions received or receivable from employer(s)2013-12-31$176,251
    Value of corrective distributions2013-12-31$790
    Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$675
    2012
    Total income from all sources2012-12-31$522,076
    Expenses. Total of all expenses incurred2012-12-31$223,042
    Benefits paid (including direct rollovers)2012-12-31$222,802
    Total plan assets at end of year2012-12-31$4,043,574
    Total plan assets at beginning of year2012-12-31$3,744,540
    Value of fidelity bond covering the plan2012-12-31$400,000
    Total contributions received or receivable from participants2012-12-31$113,262
    Other income received2012-12-31$239,670
    Net income (gross income less expenses)2012-12-31$299,034
    Net plan assets at end of year (total assets less liabilities)2012-12-31$4,043,574
    Net plan assets at beginning of year (total assets less liabilities)2012-12-31$3,744,540
    Assets. Value of assets in partnership/joint-venture interests2012-12-31$215,282
    Total contributions received or receivable from employer(s)2012-12-31$169,144
    Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$240
    2011
    Total income from all sources2011-12-31$225,362
    Expenses. Total of all expenses incurred2011-12-31$120,678
    Benefits paid (including direct rollovers)2011-12-31$120,438
    Total plan assets at end of year2011-12-31$3,744,540
    Total plan assets at beginning of year2011-12-31$3,639,856
    Value of fidelity bond covering the plan2011-12-31$400,000
    Total contributions received or receivable from participants2011-12-31$100,013
    Other income received2011-12-31$-47,904
    Net income (gross income less expenses)2011-12-31$104,684
    Net plan assets at end of year (total assets less liabilities)2011-12-31$3,744,540
    Net plan assets at beginning of year (total assets less liabilities)2011-12-31$3,639,856
    Assets. Value of assets in partnership/joint-venture interests2011-12-31$237,557
    Total contributions received or receivable from employer(s)2011-12-31$173,253
    Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$240
    2010
    Total income from all sources2010-12-31$503,253
    Expenses. Total of all expenses incurred2010-12-31$122,262
    Benefits paid (including direct rollovers)2010-12-31$122,062
    Total plan assets at end of year2010-12-31$3,639,856
    Total plan assets at beginning of year2010-12-31$3,258,865
    Value of fidelity bond covering the plan2010-12-31$400,000
    Total contributions received or receivable from participants2010-12-31$102,164
    Other income received2010-12-31$227,553
    Net income (gross income less expenses)2010-12-31$380,991
    Net plan assets at end of year (total assets less liabilities)2010-12-31$3,639,856
    Net plan assets at beginning of year (total assets less liabilities)2010-12-31$3,258,865
    Assets. Value of assets in partnership/joint-venture interests2010-12-31$68,408
    Total contributions received or receivable from employer(s)2010-12-31$173,536
    Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$200

    Form 5500 Responses

    2021
    2021-01-01Type of plan entitySingle employer plan
    2021-01-01Submission has been amendedNo
    2021-01-01This submission is the final filingNo
    2021-01-01This return/report is a short plan year return/report (less than 12 months)No
    2021-01-01Plan is a collectively bargained planNo
    2021-01-01Plan funding arrangement – InsuranceYes
    2021-01-01Plan funding arrangement – TrustYes
    2021-01-01Plan benefit arrangement – InsuranceYes
    2021-01-01Plan benefit arrangement - TrustYes
    2020
    2020-01-01Type of plan entitySingle employer plan
    2020-01-01Submission has been amendedNo
    2020-01-01This submission is the final filingNo
    2020-01-01This return/report is a short plan year return/report (less than 12 months)No
    2020-01-01Plan is a collectively bargained planNo
    2020-01-01Plan funding arrangement – InsuranceYes
    2020-01-01Plan funding arrangement – TrustYes
    2020-01-01Plan benefit arrangement – InsuranceYes
    2020-01-01Plan benefit arrangement - TrustYes
    2019
    2019-01-01Type of plan entitySingle employer plan
    2019-01-01Submission has been amendedNo
    2019-01-01This submission is the final filingNo
    2019-01-01This return/report is a short plan year return/report (less than 12 months)No
    2019-01-01Plan is a collectively bargained planNo
    2019-01-01Plan funding arrangement – InsuranceYes
    2019-01-01Plan funding arrangement – TrustYes
    2019-01-01Plan benefit arrangement – InsuranceYes
    2019-01-01Plan benefit arrangement - TrustYes
    2017
    2017-01-01Type of plan entitySingle employer plan
    2017-01-01Submission has been amendedNo
    2017-01-01This submission is the final filingNo
    2017-01-01This return/report is a short plan year return/report (less than 12 months)No
    2017-01-01Plan is a collectively bargained planNo
    2017-01-01Plan funding arrangement – InsuranceYes
    2017-01-01Plan funding arrangement – TrustYes
    2017-01-01Plan benefit arrangement – InsuranceYes
    2017-01-01Plan benefit arrangement - TrustYes
    2016
    2016-01-01Type of plan entitySingle employer plan
    2016-01-01Submission has been amendedNo
    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
    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
    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
    2013-01-01Type of plan entitySingle employer plan
    2013-01-01Submission has been amendedNo
    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
    2012-01-01Type of plan entitySingle employer plan
    2012-01-01Submission has been amendedNo
    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
    2011-01-01Type of plan entitySingle employer plan
    2011-01-01Submission has been amendedNo
    2011-01-01This submission is the final filingNo
    2011-01-01This return/report is a short plan year return/report (less than 12 months)No
    2011-01-01Plan is a collectively bargained planNo
    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
    2010-01-01Type of plan entitySingle employer plan
    2010-01-01Submission has been amendedNo
    2010-01-01This submission is the final filingNo
    2010-01-01This return/report is a short plan year return/report (less than 12 months)No
    2010-01-01Plan is a collectively bargained planNo
    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
    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

    MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
    Policy contract numberMR 60427-1
    Policy instance 1
    Insurance contract or identification numberMR 60427-1
    Number of Individuals Covered45
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Are there contracts with allocated funds for individual policies?0
    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
    MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
    Policy contract numberMR 60427-1
    Policy instance 1
    Insurance contract or identification numberMR 60427-1
    Number of Individuals Covered39
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    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
    MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
    Policy contract numberMR 60427-1
    Policy instance 1
    Insurance contract or identification numberMR 60427-1
    Number of Individuals Covered40
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    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
    MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
    Policy contract numberMR60427-1
    Policy instance 2
    Insurance contract or identification numberMR60427-1
    Number of Individuals Covered40
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $-828
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?0
    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 $-828
    Insurance broker organization code?4
    Insurance broker nameRAYMOND JAMES INSURANCE GROUP, INC.
    NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
    Policy contract numberP5000
    Policy instance 1
    Insurance contract or identification numberP5000
    Number of Individuals Covered1
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
    Health Insurance Welfare BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare 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
    NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
    Policy contract numberP5000
    Policy instance 1
    Insurance contract or identification numberP5000
    Number of Individuals Covered1
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    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?No
    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
    MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
    Policy contract numberMR60427-1
    Policy instance 2
    Insurance contract or identification numberMR60427-1
    Number of Individuals Covered42
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $4,721
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $4,721
    Insurance broker organization code?4
    Insurance broker nameRAYMOND JAMES INSURANCE GROUP, INC.
    NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
    Policy contract numberP5000
    Policy instance 1
    Insurance contract or identification numberP5000
    Number of Individuals Covered1
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?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?No
    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
    MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
    Policy contract numberMR60427-1
    Policy instance 2
    Insurance contract or identification numberMR60427-1
    Number of Individuals Covered32
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $4,571
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $372
    Insurance broker organization code?4
    Insurance broker nameRAYMOND JAMES INSURANCE GROUP INC
    MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
    Policy contract numberMR60427-1
    Policy instance 2
    Insurance contract or identification numberMR60427-1
    Number of Individuals Covered41
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $4,302
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $4,302
    Insurance broker organization code?4
    Insurance broker nameMORGAN STANLEY INS SVS INC
    NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
    Policy contract numberP5000
    Policy instance 1
    Insurance contract or identification numberP5000
    Number of Individuals Covered1
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?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?No
    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
    NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
    Policy contract numberP5000
    Policy instance 1
    Insurance contract or identification numberP5000
    Number of Individuals Covered1
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?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?No
    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
    MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
    Policy contract numberMR60427-1
    Policy instance 2
    Insurance contract or identification numberMR60427-1
    Number of Individuals Covered40
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $4,083
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $4,083
    Insurance broker organization code?4
    Insurance broker nameMORGAN STANLEY INS SVS INC
    MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
    Policy contract numberMR60427-1
    Policy instance 2
    Insurance contract or identification numberMR60427-1
    Number of Individuals Covered38
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $3,781
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating 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
    NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
    Policy contract numberP5000
    Policy instance 1
    Insurance contract or identification numberP5000
    Number of Individuals Covered1
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?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?No
    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
    MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
    Policy contract numberMR60427-1
    Policy instance 2
    Insurance contract or identification numberMR60427-1
    Number of Individuals Covered40
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-02
    Total amount of commissions paid to insurance brokerUSD $4,057
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?No
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $4,057
    Insurance broker organization code?4
    Insurance broker nameMORGAN STANLEY INS SVS INC
    NEW YORK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66915 )
    Policy contract numberP5000
    Policy instance 1
    Insurance contract or identification numberP5000
    Number of Individuals Covered1
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Are there contracts with allocated funds for individual policies?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?No
    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

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