401k Plan data: VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN plan

VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 401k Plan overview

Plan Name	VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN
Plan identification number	001

VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

VALLEY EAR NOSE & THROAT SPECIALIST P.A. has sponsored the creation of one or more 401k plans.

Company Name: VALLEY EAR NOSE & THROAT SPECIALIST P.A.

Employer identification number (EIN): 742139209

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01 JOSEPH HEMER, DO 2019-07-23
001 2017-01-01 JOSEPH HEMER, DO 2018-07-19 JOSEPH HEMER, DO 2018-07-19
001 2016-01-01
001 2015-01-01
001 2014-01-01 JOSEPH H. HEMER 2015-07-21
001 2013-01-01 JAMES J. SORCE 2014-10-07
001 2012-01-01 JAMES J. SORCE 2013-06-03
001 2011-01-01 JAMES J. SORCE 2012-06-01
001 2010-01-01 JAMES J. SORCE 2011-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01	JOSEPH HEMER, DO	2019-07-23
001	2017-01-01	JOSEPH HEMER, DO	2018-07-19	JOSEPH HEMER, DO	2018-07-19
001	2016-01-01
001	2015-01-01
001	2014-01-01	JOSEPH H. HEMER	2015-07-21
001	2013-01-01	JAMES J. SORCE	2014-10-07
001	2012-01-01	JAMES J. SORCE	2013-06-03
001	2011-01-01	JAMES J. SORCE	2012-06-01
001	2010-01-01	JAMES J. SORCE	2011-10-13

Plan Statistics for VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN

401k plan membership statisitcs for VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN

Measure Date Value
2021: VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 82
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 76
Total of all active and inactive participants 2021-01-01 158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 158
Number of participants with account balances 2021-01-01 158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 3
2020: VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 150
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 84
Number of retired or separated participants receiving benefits 2020-01-01 17
Number of other retired or separated participants entitled to future benefits 2020-01-01 56
Total of all active and inactive participants 2020-01-01 157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 157
Number of participants with account balances 2020-01-01 157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 6
2019: VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 74
Number of retired or separated participants receiving benefits 2019-01-01 11
Number of other retired or separated participants entitled to future benefits 2019-01-01 49
Total of all active and inactive participants 2019-01-01 134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 134
Number of participants with account balances 2019-01-01 134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 5

Measure	Date	Value
2021: VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	82
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	76
Total of all active and inactive participants	2021-01-01	158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	158
Number of participants with account balances	2021-01-01	158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	3
2020: VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	150
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	84
Number of retired or separated participants receiving benefits	2020-01-01	17
Number of other retired or separated participants entitled to future benefits	2020-01-01	56
Total of all active and inactive participants	2020-01-01	157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	157
Number of participants with account balances	2020-01-01	157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	6
2019: VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	74
Number of retired or separated participants receiving benefits	2019-01-01	11
Number of other retired or separated participants entitled to future benefits	2019-01-01	49
Total of all active and inactive participants	2019-01-01	134
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	134
Number of participants with account balances	2019-01-01	134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	5

Financial Data on VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN

Measure	Date	Value
2021 : VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$1,688,673
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$365,137
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$358,242
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$589,386
Value of total assets at end of year	2021-12-31	$10,722,073
Value of total assets at beginning of year	2021-12-31	$9,398,537
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$6,895
Total interest from all sources	2021-12-31	$11,626
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$205,542
Participant contributions at end of year	2021-12-31	$218,180
Participant contributions at beginning of year	2021-12-31	$266,506
Total non interest bearing cash at end of year	2021-12-31	$5,816
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$1,323,536
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$10,722,073
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$9,398,537
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$9,511,655
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$8,250,900
Interest on participant loans	2021-12-31	$11,626
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$602,578
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$560,845
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$1,087,661
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$383,844
Employer contributions (assets) at end of year	2021-12-31	$383,844
Employer contributions (assets) at beginning of year	2021-12-31	$320,286
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$358,242
Contract administrator fees	2021-12-31	$6,895
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Disclaimer
Accountancy firm name	2021-12-31	SQUIRE & COMPANY, P.C,
Accountancy firm EIN	2021-12-31	870343246
2020 : VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$1,554,989
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$960,311
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$954,446
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$540,314
Value of total assets at end of year	2020-12-31	$9,398,537
Value of total assets at beginning of year	2020-12-31	$8,803,859
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$5,865
Total interest from all sources	2020-12-31	$12,104
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 year	2020-12-31	No
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$220,028
Participant contributions at end of year	2020-12-31	$266,506
Participant contributions at beginning of year	2020-12-31	$176,883
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$594,678
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$9,398,537
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$8,803,859
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$8,250,900
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$8,251,078
Interest on participant loans	2020-12-31	$12,104
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$560,845
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$50,706
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$1,002,571
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$320,286
Employer contributions (assets) at end of year	2020-12-31	$320,286
Employer contributions (assets) at beginning of year	2020-12-31	$325,192
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$954,446
Contract administrator fees	2020-12-31	$5,865
Did the plan have assets held for investment	2020-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Disclaimer
Accountancy firm name	2020-12-31	SQUIRE AND COMPANY, PC
Accountancy firm EIN	2020-12-31	870343246
2019 : VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end 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	$1,846,101
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$96,217
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$89,352
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$544,600
Value of total assets at end of year	2019-12-31	$8,803,859
Value of total assets at beginning of year	2019-12-31	$7,053,975
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$6,865
Total interest from all sources	2019-12-31	$11,126
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 year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$216,047
Participant contributions at end of year	2019-12-31	$176,883
Participant contributions at beginning of year	2019-12-31	$239,794
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$3,361
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$1,749,884
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$8,803,859
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$7,053,975
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$8,251,078
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$6,188,578
Interest on participant loans	2019-12-31	$11,126
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$50,706
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$297,686
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$1,290,375
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$325,192
Employer contributions (assets) at end of year	2019-12-31	$325,192
Employer contributions (assets) at beginning of year	2019-12-31	$327,917
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$89,352
Contract administrator fees	2019-12-31	$6,865
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	SQUIRE & COMPANY, PC
Accountancy firm EIN	2019-12-31	870343246

Form 5500 Responses for VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN

2021: VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: VALLEY EAR NOSE & THROAT SPECIALIST, P.A. 401K PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

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

Policy contract number

GA-832389

Policy instance

Insurance contract or identification number	GA-832389
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $18,341
Total amount of fees paid to insurance company	USD $4,585
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $18,341
Insurance broker organization code?	3
Amount paid for insurance broker fees	4585
Additional information about fees paid to insurance broker	TPA FEES

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

Policy contract number

GA-832389

Policy instance

Insurance contract or identification number	GA-832389
Number of Individuals Covered	135
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $16,326
Total amount of fees paid to insurance company	USD $4,073
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $16,326
Insurance broker organization code?	3
Amount paid for insurance broker fees	4073
Additional information about fees paid to insurance broker	TPA FEES

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

Policy contract number

GA-832389

Policy instance

Insurance contract or identification number	GA-832389
Number of Individuals Covered	119
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $10,979
Total amount of fees paid to insurance company	USD $3,576
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No

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Company Name:	VALLEY EAR NOSE & THROAT SPECIALIST P.A.
Employer identification number (EIN):	742139209
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)