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JUPITER MEDICAL GROUP 401k Plan overview

Plan NameJUPITER MEDICAL GROUP
Plan identification number 002

JUPITER MEDICAL GROUP Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

JUPITER MEDICAL GROUP, INC. has sponsored the creation of one or more 401k plans.

Company Name:JUPITER MEDICAL GROUP, INC.
Employer identification number (EIN):651040979
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JUPITER MEDICAL GROUP

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022021-01-01
0022020-01-01RAJENDRA BANSAL MD2021-10-13
0022019-01-01RAJENDRA BANSAL MD2020-10-15
0022018-01-01STELLIE OTT2019-06-07
0022017-01-01STELLIE OTT2018-05-21
0022016-01-01STELLIAN OTT2017-06-09
0022015-01-01STELLIAN OTT2016-06-15

Plan Statistics for JUPITER MEDICAL GROUP

401k plan membership statisitcs for JUPITER MEDICAL GROUP

Measure Date Value
2021: JUPITER MEDICAL GROUP 2021 401k membership
Total participants, beginning-of-year2021-01-01178
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-010
Number of participants with account balances2021-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: JUPITER MEDICAL GROUP 2020 401k membership
Total participants, beginning-of-year2020-01-01176
Total number of active participants reported on line 7a of the Form 55002020-01-01169
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-019
Total of all active and inactive participants2020-01-01178
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01178
Number of participants with account balances2020-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: JUPITER MEDICAL GROUP 2019 401k membership
Total participants, beginning-of-year2019-01-01139
Total number of active participants reported on line 7a of the Form 55002019-01-01171
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-015
Total of all active and inactive participants2019-01-01177
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01177
Number of participants with account balances2019-01-0137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010

Financial Data on JUPITER MEDICAL GROUP

Measure Date Value
2021 : JUPITER MEDICAL GROUP 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$15,914
Total income from all sources (including contributions)2021-09-30$177,435
Total loss/gain on sale of assets2021-09-30$0
Total of all expenses incurred2021-09-30$1,324,696
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-09-30$1,324,696
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-09-30$79,387
Value of total assets at end of year2021-09-30$0
Value of total assets at beginning of year2021-09-30$1,163,175
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-09-30$0
Total interest from all sources2021-09-30$279
Total dividends received (eg from common stock, registered investment company shares)2021-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-09-30No
Was this plan covered by a fidelity bond2021-09-30Yes
Value of fidelity bond cover2021-09-30$125,000
If this is an individual account plan, was there a blackout period2021-09-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-09-30$0
Were there any nonexempt tranactions with any party-in-interest2021-09-30No
Contributions received from participants2021-09-30$79,387
Participant contributions at end of year2021-09-30$0
Participant contributions at beginning of year2021-09-30$13,870
Participant contributions at end of year2021-09-30$0
Participant contributions at beginning of year2021-09-30$879
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-09-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-09-30$23
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-09-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-09-30$15,914
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Value of net income/loss2021-09-30$-1,147,261
Value of net assets at end of year (total assets less liabilities)2021-09-30$0
Value of net assets at beginning of year (total assets less liabilities)2021-09-30$1,147,261
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-09-30No
Were any leases to which the plan was party in default or uncollectible2021-09-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-09-30$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-09-30$1,148,403
Interest on participant loans2021-09-30$279
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-09-30$97,769
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-09-30No
Was there a failure to transmit to the plan any participant contributions2021-09-30No
Has the plan failed to provide any benefit when due under the plan2021-09-30No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-09-30$1,324,696
Did the plan have assets held for investment2021-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-09-30Yes
Opinion of an independent qualified public accountant for this plan2021-09-30Disclaimer
Accountancy firm name2021-09-30KSDT AND COMPANY
Accountancy firm EIN2021-09-30260547877
2020 : JUPITER MEDICAL GROUP 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$15,914
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$30,357
Total income from all sources (including contributions)2020-12-31$487,699
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$70,145
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$68,550
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$278,896
Value of total assets at end of year2020-12-31$1,163,175
Value of total assets at beginning of year2020-12-31$760,064
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$1,595
Total interest from all sources2020-12-31$636
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$125,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$203,993
Participant contributions at end of year2020-12-31$13,870
Participant contributions at beginning of year2020-12-31$2,063
Participant contributions at end of year2020-12-31$879
Participant contributions at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$74,903
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$23
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$242
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$15,914
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$30,357
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$417,554
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,147,261
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$729,707
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$1,148,403
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$757,759
Interest on participant loans2020-12-31$636
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$208,167
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$68,550
Contract administrator fees2020-12-31$1,595
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31KSDT AND COMPANY
Accountancy firm EIN2020-12-31260547877
2019 : JUPITER MEDICAL GROUP 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total transfer of assets to this plan2019-12-31$29,102
Total transfer of assets to this plan2019-12-31$29,102
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$30,357
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$30,357
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$292,116
Total income from all sources (including contributions)2019-12-31$292,116
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$39,891
Total of all expenses incurred2019-12-31$39,891
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$39,113
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$39,113
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$173,891
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$173,891
Value of total assets at end of year2019-12-31$760,064
Value of total assets at end of year2019-12-31$760,064
Value of total assets at beginning of year2019-12-31$448,380
Value of total assets at beginning of year2019-12-31$448,380
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$778
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$778
Total interest from all sources2019-12-31$62
Total interest from all sources2019-12-31$62
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$40,000
Value of fidelity bond cover2019-12-31$40,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$132,631
Contributions received from participants2019-12-31$132,631
Participant contributions at end of year2019-12-31$2,063
Participant contributions at end of year2019-12-31$2,063
Participant contributions at beginning of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$41,260
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$41,260
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$242
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$242
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$30,357
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$30,357
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$252,225
Value of net income/loss2019-12-31$252,225
Value of net assets at end of year (total assets less liabilities)2019-12-31$729,707
Value of net assets at end of year (total assets less liabilities)2019-12-31$729,707
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$448,380
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$448,380
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$757,759
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$757,759
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$448,380
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$448,380
Interest on participant loans2019-12-31$62
Interest on participant loans2019-12-31$62
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$118,163
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$118,163
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$39,113
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$39,113
Contract administrator fees2019-12-31$778
Contract administrator fees2019-12-31$778
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31KSDT AND COMPANY
Accountancy firm name2019-12-31KSDT AND COMPANY
Accountancy firm EIN2019-12-31260547877
Accountancy firm EIN2019-12-31260547877

Form 5500 Responses for JUPITER MEDICAL GROUP

2021: JUPITER MEDICAL GROUP 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingYes
2021-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: JUPITER MEDICAL GROUP 2020 form 5500 responses
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 – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: JUPITER MEDICAL GROUP 2019 form 5500 responses
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 – TrustYes
2019-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number962-80078
Policy instance 1
Insurance contract or identification number962-80078
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $51
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
Amount paid for insurance broker fees51
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?4
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number962-80078
Policy instance 1
Insurance contract or identification number962-80078
Number of Individuals Covered40
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 $81
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
Amount paid for insurance broker fees81
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?4
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number962-80078
Policy instance 1
Insurance contract or identification number962-80078
Number of Individuals Covered37
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 $16
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
Amount paid for insurance broker fees16
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?4

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