401k Plan data: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN plan

MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 401k Plan overview

Plan Name	MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN
Plan identification number	001

MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN Benefits

401k Plan Type

Defined 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.
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

MEDICAL REVIEW INSTITUTE OF AMERICA has sponsored the creation of one or more 401k plans.

Company Name: MEDICAL REVIEW INSTITUTE OF AMERICA

Employer identification number (EIN): 870394756

NAIC Classification: 524290

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2015-01-01 WILLIAM LOW WILLIAM LOW 2016-05-17
001 2014-01-01 WILLIAM LOW WILLIAM LOW 2015-04-23
001 2013-01-01 WILLIAM LOW WILLIAM LOW 2014-06-10
001 2012-01-01 WILLIAM LOW WILLIAM LOW 2013-05-28
001 2011-01-01 WILLIAM LOW WILLIAM LOW 2012-06-06
001 2009-01-01 WILLIAM LOW WILLIAM LOW 2010-07-26

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
001	2015-01-01	WILLIAM LOW	WILLIAM LOW	2016-05-17
001	2014-01-01	WILLIAM LOW	WILLIAM LOW	2015-04-23
001	2013-01-01	WILLIAM LOW	WILLIAM LOW	2014-06-10
001	2012-01-01	WILLIAM LOW	WILLIAM LOW	2013-05-28
001	2011-01-01	WILLIAM LOW	WILLIAM LOW	2012-06-06
001	2009-01-01	WILLIAM LOW	WILLIAM LOW	2010-07-26

Plan Statistics for MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN

401k plan membership statisitcs for MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN

Measure Date Value
2015: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 93
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 104
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 9
Total of all active and inactive participants 2015-01-01 113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 113
Number of participants with account balances 2015-01-01 95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 4
2014: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 88
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 87
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 5
Total of all active and inactive participants 2014-01-01 92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 92
Number of participants with account balances 2014-01-01 73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 5
2013: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 78
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 80
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 6
Total of all active and inactive participants 2013-01-01 86
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 86
Number of participants with account balances 2013-01-01 67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 8
2012: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 68
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 72
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 2
Total of all active and inactive participants 2012-01-01 74
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 75
Number of participants with account balances 2012-01-01 60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 75
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 65
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 1
Total of all active and inactive participants 2011-01-01 66
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 67
Number of participants with account balances 2011-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 59
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 55
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 7
Total of all active and inactive participants 2009-01-01 62
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 1
Total participants 2009-01-01 63
Number of participants with account balances 2009-01-01 54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2015: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	93
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	104
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	9
Total of all active and inactive participants	2015-01-01	113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	113
Number of participants with account balances	2015-01-01	95
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	4
2014: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	88
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	87
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	5
Total of all active and inactive participants	2014-01-01	92
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	92
Number of participants with account balances	2014-01-01	73
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	5
2013: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	78
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	80
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	6
Total of all active and inactive participants	2013-01-01	86
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	86
Number of participants with account balances	2013-01-01	67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	8
2012: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	68
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	72
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	2
Total of all active and inactive participants	2012-01-01	74
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	75
Number of participants with account balances	2012-01-01	60
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	75
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	65
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	1
Total of all active and inactive participants	2011-01-01	66
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	67
Number of participants with account balances	2011-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	59
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	55
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	7
Total of all active and inactive participants	2009-01-01	62
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	63
Number of participants with account balances	2009-01-01	54
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN

Measure	Date	Value
2015 : MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2015 401k financial data
Transfers to/from the plan	2015-12-31	$0
Total plan liabilities at end of year	2015-12-31	$102,148
Total plan liabilities at beginning of year	2015-12-31	$44,816
Total income from all sources	2015-12-31	$751,436
Expenses. Total of all expenses incurred	2015-12-31	$229,738
Benefits paid (including direct rollovers)	2015-12-31	$94,784
Total plan assets at end of year	2015-12-31	$5,209,081
Total plan assets at beginning of year	2015-12-31	$4,630,051
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$511,800
Expenses. Other expenses not covered elsewhere	2015-12-31	$32,806
Contributions received from other sources (not participants or employers)	2015-12-31	$1,530
Other income received	2015-12-31	$-91,194
Noncash contributions received	2015-12-31	$0
Net income (gross income less expenses)	2015-12-31	$521,698
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$5,106,933
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$4,585,235
Assets. Value of participant loans	2015-12-31	$145,397
Total contributions received or receivable from employer(s)	2015-12-31	$329,300
Value of certain deemed distributions of participant loans	2015-12-31	$0
Value of corrective distributions	2015-12-31	$102,148
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total plan liabilities at end of year	2014-12-31	$44,816
Total plan liabilities at beginning of year	2014-12-31	$71,350
Total income from all sources	2014-12-31	$812,501
Expenses. Total of all expenses incurred	2014-12-31	$474,721
Benefits paid (including direct rollovers)	2014-12-31	$399,688
Total plan assets at end of year	2014-12-31	$4,630,051
Total plan assets at beginning of year	2014-12-31	$4,318,805
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$398,775
Expenses. Other expenses not covered elsewhere	2014-12-31	$30,217
Contributions received from other sources (not participants or employers)	2014-12-31	$12,282
Other income received	2014-12-31	$158,088
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$337,780
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$4,585,235
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$4,247,455
Assets. Value of participant loans	2014-12-31	$144,946
Total contributions received or receivable from employer(s)	2014-12-31	$243,356
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$44,816
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total plan liabilities at end of year	2013-12-31	$71,350
Total plan liabilities at beginning of year	2013-12-31	$6,549
Total income from all sources	2013-12-31	$1,159,241
Expenses. Total of all expenses incurred	2013-12-31	$599,719
Benefits paid (including direct rollovers)	2013-12-31	$499,987
Total plan assets at end of year	2013-12-31	$4,318,805
Total plan assets at beginning of year	2013-12-31	$3,694,482
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$329,457
Expenses. Other expenses not covered elsewhere	2013-12-31	$30,686
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$645,784
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$559,522
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$4,247,455
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$3,687,933
Assets. Value of participant loans	2013-12-31	$117,111
Total contributions received or receivable from employer(s)	2013-12-31	$184,000
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$69,046
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 : MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$6,549
Total plan liabilities at beginning of year	2012-12-31	$14,116
Total income from all sources	2012-12-31	$975,547
Expenses. Total of all expenses incurred	2012-12-31	$268,057
Benefits paid (including direct rollovers)	2012-12-31	$236,248
Total plan assets at end of year	2012-12-31	$3,694,482
Total plan assets at beginning of year	2012-12-31	$2,994,559
Value of fidelity bond covering the plan	2012-12-31	$375,000
Total contributions received or receivable from participants	2012-12-31	$327,599
Expenses. Other expenses not covered elsewhere	2012-12-31	$25,260
Contributions received from other sources (not participants or employers)	2012-12-31	$5,699
Other income received	2012-12-31	$443,249
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$707,490
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$3,687,933
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,980,443
Assets. Value of participant loans	2012-12-31	$65,189
Total contributions received or receivable from employer(s)	2012-12-31	$199,000
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$6,549
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$14,116
Total plan liabilities at beginning of year	2011-12-31	$22,958
Total income from all sources	2011-12-31	$378,685
Expenses. Total of all expenses incurred	2011-12-31	$385,550
Benefits paid (including direct rollovers)	2011-12-31	$347,721
Total plan assets at end of year	2011-12-31	$2,994,559
Total plan assets at beginning of year	2011-12-31	$3,010,266
Value of fidelity bond covering the plan	2011-12-31	$300,000
Total contributions received or receivable from participants	2011-12-31	$301,473
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$10
Other income received	2011-12-31	$-122,053
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-6,865
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,980,443
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,987,308
Assets. Value of participant loans	2011-12-31	$83,282
Total contributions received or receivable from employer(s)	2011-12-31	$199,255
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$14,116
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$23,713
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$22,958
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$876,630
Expenses. Total of all expenses incurred	2010-12-31	$207,391
Benefits paid (including direct rollovers)	2010-12-31	$165,644
Total plan assets at end of year	2010-12-31	$3,010,266
Total plan assets at beginning of year	2010-12-31	$2,318,069
Value of fidelity bond covering the plan	2010-12-31	$300,000
Total contributions received or receivable from participants	2010-12-31	$304,725
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$31,916
Other income received	2010-12-31	$337,626
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$669,239
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$2,987,308
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,318,069
Assets. Value of participant loans	2010-12-31	$84,874
Total contributions received or receivable from employer(s)	2010-12-31	$202,363
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$22,958
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$18,789
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN

2015: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 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 benefit arrangement – Insurance	Yes
2009: MEDICAL REVIEW INSTITUTE OF AMERICA 401(K) PLAN 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 benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

93925

Policy instance

Insurance contract or identification number	93925
Number of Individuals Covered	95
Insurance policy start date	2015-10-07
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $29,954
Amount paid for insurance broker fees	29954
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Insurance broker name	WC ADMINISTRATORS, LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

93925

Policy instance

Insurance contract or identification number	93925
Number of Individuals Covered	73
Insurance policy start date	2014-10-07
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $26,888
Amount paid for insurance broker fees	26888
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Insurance broker name	WC ADMINISTRATORS, LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

93925

Policy instance

Insurance contract or identification number	93925
Number of Individuals Covered	67
Insurance policy start date	2013-10-07
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 $24,225
Amount paid for insurance broker fees	24225
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Insurance broker name	WC ADMINISTRATORS, LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

93925

Policy instance

Insurance contract or identification number	93925
Number of Individuals Covered	60
Insurance policy start date	2012-10-07
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
Insurance broker organization code?	5
Insurance broker name	WC ADMINISTRATORS, LLC

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

93925

Policy instance

Insurance contract or identification number	93925
Number of Individuals Covered	50
Insurance policy start date	2011-10-07
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 $18,546

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )

Policy contract number

93925

Policy instance

Insurance contract or identification number	93925
Number of Individuals Covered	59
Insurance policy start date	2010-10-07
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $14,890
Amount paid for insurance broker fees	14890
Additional information about fees paid to insurance broker	TPA FEES
Insurance broker organization code?	5
Insurance broker name	WC ADMINISTRATORS, LLC

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Company Name:	MEDICAL REVIEW INSTITUTE OF AMERICA
Employer identification number (EIN):	870394756
NAIC Classification:	524290