401k Plan data: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST plan

EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 401k Plan overview

Plan Name	EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST
Plan identification number	002

EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 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.
Participant-directed brokerage accounts provided as an investment option under the plan.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Life insurance

401k Sponsoring company profile

EAR, NOSE & THROAT GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name: EAR, NOSE & THROAT GROUP, INC.

Employer identification number (EIN): 620809862

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2018-01-01
002 2017-01-01
002 2016-01-01
002 2015-01-01 CHRISTOPHER HALL 2016-09-15
002 2014-01-01 CHRISTOPHER HALL 2015-09-11
002 2013-01-01 CHRISTOPHER HALL
002 2012-01-01 CHRISTOPHER HALL
002 2011-01-01 CHRISTOPHER J. HALL CHRISTOPHER J. HALL 2012-09-11
002 2010-01-01 CHRISTOPHER J. HALL CHRISTOPHER J. HALL 2011-07-14
002 2009-01-01 LIBBY WREN
002 2009-01-01 LIBBY WREN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2018-01-01
002	2017-01-01
002	2016-01-01
002	2015-01-01	CHRISTOPHER HALL	2016-09-15
002	2014-01-01	CHRISTOPHER HALL	2015-09-11
002	2013-01-01	CHRISTOPHER HALL
002	2012-01-01	CHRISTOPHER HALL
002	2011-01-01	CHRISTOPHER J. HALL		CHRISTOPHER J. HALL	2012-09-11
002	2010-01-01	CHRISTOPHER J. HALL		CHRISTOPHER J. HALL	2011-07-14
002	2009-01-01	LIBBY WREN
002	2009-01-01	LIBBY WREN

Plan Statistics for EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST

401k plan membership statisitcs for EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST

Measure Date Value
2013: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 20
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 5
Total of all active and inactive participants 2013-01-01 25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 25
Number of participants with account balances 2013-01-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 15
Number of other retired or separated participants entitled to future benefits 2012-01-01 12
Total of all active and inactive participants 2012-01-01 27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 27
Number of participants with account balances 2012-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 25
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 16
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 9
Total of all active and inactive participants 2011-01-01 25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 25
Number of participants with account balances 2011-01-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 1
2010: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 14
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 7
Total of all active and inactive participants 2010-01-01 21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 21
Number of participants with account balances 2010-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 15
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 2
Total of all active and inactive participants 2009-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 17
Number of participants with account balances 2009-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 4

Measure	Date	Value
2013: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	20
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	5
Total of all active and inactive participants	2013-01-01	25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	25
Number of participants with account balances	2013-01-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	15
Number of other retired or separated participants entitled to future benefits	2012-01-01	12
Total of all active and inactive participants	2012-01-01	27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	27
Number of participants with account balances	2012-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	25
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	16
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	9
Total of all active and inactive participants	2011-01-01	25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	25
Number of participants with account balances	2011-01-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	1
2010: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	14
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	7
Total of all active and inactive participants	2010-01-01	21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	21
Number of participants with account balances	2010-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	15
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	2
Total of all active and inactive participants	2009-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	17
Number of participants with account balances	2009-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	4

Financial Data on EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST

Measure	Date	Value
2013 : EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 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	$426,605
Expenses. Total of all expenses incurred	2013-12-31	$2,545,822
Benefits paid (including direct rollovers)	2013-12-31	$2,534,583
Total plan assets at end of year	2013-12-31	$574,099
Total plan assets at beginning of year	2013-12-31	$2,693,316
Value of fidelity bond covering the plan	2013-12-31	$100,000
Total contributions received or receivable from participants	2013-12-31	$96,197
Expenses. Other expenses not covered elsewhere	2013-12-31	$11,239
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$274,910
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$-2,119,217
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$574,099
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,693,316
Total contributions received or receivable from employer(s)	2013-12-31	$55,498
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	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 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	$869,030
Expenses. Total of all expenses incurred	2012-12-31	$7,039,636
Benefits paid (including direct rollovers)	2012-12-31	$7,038,952
Total plan assets at end of year	2012-12-31	$2,693,316
Total plan assets at beginning of year	2012-12-31	$8,863,922
Value of fidelity bond covering the plan	2012-12-31	$750,000
Total contributions received or receivable from participants	2012-12-31	$93,082
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	$726,905
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$-6,170,606
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,693,316
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$8,863,922
Total contributions received or receivable from employer(s)	2012-12-31	$49,043
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	$684
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2011 401k financial data
Total income from all sources	2011-12-31	$304,148
Expenses. Total of all expenses incurred	2011-12-31	$361,286
Benefits paid (including direct rollovers)	2011-12-31	$361,286
Total plan assets at end of year	2011-12-31	$8,863,922
Total plan assets at beginning of year	2011-12-31	$8,921,060
Value of fidelity bond covering the plan	2011-12-31	$750,000
Total contributions received or receivable from participants	2011-12-31	$88,810
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	$148,639
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-57,138
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$8,863,922
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$8,921,060
Total contributions received or receivable from employer(s)	2011-12-31	$66,699
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$1,042,395
Expenses. Total of all expenses incurred	2010-12-31	$312,568
Benefits paid (including direct rollovers)	2010-12-31	$311,350
Total plan assets at end of year	2010-12-31	$8,921,060
Total plan assets at beginning of year	2010-12-31	$8,191,233
Value of fidelity bond covering the plan	2010-12-31	$750,000
Total contributions received or receivable from participants	2010-12-31	$113,929
Expenses. Other expenses not covered elsewhere	2010-12-31	$1,218
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$873,486
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$729,827
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$8,921,060
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$8,191,233
Total contributions received or receivable from employer(s)	2010-12-31	$54,980
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST

2013: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 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: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 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: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
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
2010: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: EAR, NOSE & THROAT GROUP, INC. PROFIT SHARING PLAN & TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

3349343-01

Policy instance

Insurance contract or identification number	3349343-01
Number of Individuals Covered	11
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $244
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for group deferred annuity?	Yes
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Commission paid to Insurance Broker	USD $244
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO ADVISORS LLC

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

304620069

Policy instance

Insurance contract or identification number	304620069
Number of Individuals Covered	0
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $4,656
Amount paid for insurance broker fees	4656
Insurance broker organization code?	3
Insurance broker name	ROPER-COLCOLOUGH WEALTH

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

E1070990

Policy instance

Insurance contract or identification number	E1070990
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3
Insurance broker name	MARK RULEMAN

METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 )

Policy contract number

3203491442

Policy instance

Insurance contract or identification number	3203491442
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3
Insurance broker name	MARK RULEMAN

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

304620069

Policy instance

Insurance contract or identification number	304620069
Number of Individuals Covered	1
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,906
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $2,900
Insurance broker organization code?	3
Insurance broker name	JOHN J. COLCOLOUGH

PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )

Policy contract number

966085F

Policy instance

Insurance contract or identification number	966085F
Number of Individuals Covered	0
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3
Insurance broker name	WALLACE F. BILLINGS

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

3349343-01

Policy instance

Insurance contract or identification number	3349343-01
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 $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for group deferred annuity?	Yes
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

E1070990

Policy instance

Insurance contract or identification number	E1070990
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $280
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

METLIFE INVESTORS USA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61050 )

Policy contract number

3203491442

Policy instance

Insurance contract or identification number	3203491442
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )

Policy contract number

966085F

Policy instance

Insurance contract or identification number	966085F
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $124
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

304620069

Policy instance

Insurance contract or identification number	304620069
Number of Individuals Covered	1
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,138
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )

Policy contract number

966085F

Policy instance

Insurance contract or identification number	966085F
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $124
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $124
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	WALLACE F. BILLINGS

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

304620069

Policy instance

Insurance contract or identification number	304620069
Number of Individuals Covered	1
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,521
Total amount of fees paid to insurance company	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,521
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES R. ROPER

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Company Name:	EAR, NOSE & THROAT GROUP, INC.
Employer identification number (EIN):	620809862
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)