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CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameCENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN
Plan identification number 001

CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined 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.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan covering Self-Employed individuals.
  • 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

CENTRAL OREGON PEDIATRIC ASSOCIATES has sponsored the creation of one or more 401k plans.

Company Name:CENTRAL OREGON PEDIATRIC ASSOCIATES
Employer identification number (EIN):930731016
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01MARY ROGERS2023-09-21
0012021-01-01LOGAN THOMAS CLAUSEN2022-07-25
0012020-01-01JEFFREY MEYROWITZ MD2021-07-19
0012019-01-01JEFFREY MEYROWITZ MD2020-07-28
0012018-01-01DANA PERRYMAN MD2019-10-09
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01JOHN D PEOPLES MD2015-09-22
0012013-01-01JENNIFER LACHMAN MD2014-08-20
0012012-01-01JENNIFER LACHMAN MD2013-07-03
0012011-01-01JENNIFER LACHMAN MD2012-07-06
0012010-01-01DALE SVENDSEN MD2011-12-29

Plan Statistics for CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN

Measure Date Value
2022: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01152
Total number of active participants reported on line 7a of the Form 55002022-01-01117
Number of retired or separated participants receiving benefits2022-01-017
Number of other retired or separated participants entitled to future benefits2022-01-0133
Total of all active and inactive participants2022-01-01157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01157
Number of participants with account balances2022-01-01157
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0118
2021: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01134
Total number of active participants reported on line 7a of the Form 55002021-01-01114
Number of retired or separated participants receiving benefits2021-01-0111
Number of other retired or separated participants entitled to future benefits2021-01-0125
Total of all active and inactive participants2021-01-01150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01150
Number of participants with account balances2021-01-01150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-0119
2020: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01124
Total number of active participants reported on line 7a of the Form 55002020-01-01106
Number of retired or separated participants receiving benefits2020-01-014
Number of other retired or separated participants entitled to future benefits2020-01-0117
Total of all active and inactive participants2020-01-01127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01127
Number of participants with account balances2020-01-01126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0110
2019: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01118
Total number of active participants reported on line 7a of the Form 55002019-01-0193
Number of retired or separated participants receiving benefits2019-01-016
Number of other retired or separated participants entitled to future benefits2019-01-0119
Total of all active and inactive participants2019-01-01118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01118
Number of participants with account balances2019-01-01118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-0115
2018: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01122
Total number of active participants reported on line 7a of the Form 55002018-01-0197
Number of retired or separated participants receiving benefits2018-01-016
Number of other retired or separated participants entitled to future benefits2018-01-0111
Total of all active and inactive participants2018-01-01114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01114
Number of participants with account balances2018-01-01114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-019
2017: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01121
Total number of active participants reported on line 7a of the Form 55002017-01-0187
Number of retired or separated participants receiving benefits2017-01-015
Number of other retired or separated participants entitled to future benefits2017-01-0128
Total of all active and inactive participants2017-01-01120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01120
Number of participants with account balances2017-01-01120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-0114

Financial Data on CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN

Measure Date Value
2022 : CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$-362,802
Total unrealized appreciation/depreciation of assets2022-12-31$-362,802
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-871,872
Total loss/gain on sale of assets2022-12-31$-338,003
Total of all expenses incurred2022-12-31$1,352,145
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,278,799
Value of total corrective distributions2022-12-31$20
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,120,968
Value of total assets at end of year2022-12-31$11,353,673
Value of total assets at beginning of year2022-12-31$13,577,690
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$73,326
Total interest from all sources2022-12-31$9,649
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$182,887
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$182,887
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$533,390
Participant contributions at end of year2022-12-31$62,156
Participant contributions at beginning of year2022-12-31$107,122
Participant contributions at end of year2022-12-31$29,300
Participant contributions at beginning of year2022-12-31$6,600
Assets. Other investments not covered elsewhere at end of year2022-12-31$2,279,295
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$2,909,131
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$26,800
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$833
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$1,164
Other income not declared elsewhere2022-12-31$42
Administrative expenses (other) incurred2022-12-31$7,038
Total non interest bearing cash at end of year2022-12-31$0
Total non interest bearing cash at beginning of year2022-12-31$2,237
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-2,224,017
Value of net assets at end of year (total assets less liabilities)2022-12-31$11,353,673
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$13,577,690
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$44,688
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$8,344,846
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$9,259,661
Interest on participant loans2022-12-31$4,494
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$355,686
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$317,458
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$317,458
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$5,155
Asset value of US Government securities at end of year2022-12-31$137,149
Asset value of US Government securities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-626,539
Net investment gain/loss from pooled separate accounts2022-12-31$-858,074
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31Yes
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$560,778
Employer contributions (assets) at end of year2022-12-31$131,930
Employer contributions (assets) at beginning of year2022-12-31$88,521
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,278,799
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$2,536
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$0
Contract administrator fees2022-12-31$21,600
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$9,942
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$885,796
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$1,924,576
Aggregate carrying amount (costs) on sale of assets2022-12-31$2,262,579
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31JONES & ROTH
Accountancy firm EIN2022-12-31930819646
2021 : CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-12-31$548,991
Total unrealized appreciation/depreciation of assets2021-12-31$548,991
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$50
Total income from all sources (including contributions)2021-12-31$2,679,827
Total loss/gain on sale of assets2021-12-31$-52,517
Total of all expenses incurred2021-12-31$1,222,884
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,141,857
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,031,428
Value of total assets at end of year2021-12-31$13,577,690
Value of total assets at beginning of year2021-12-31$12,120,797
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$81,027
Total interest from all sources2021-12-31$8,867
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$235,605
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$390,606
Participant contributions at end of year2021-12-31$107,122
Participant contributions at beginning of year2021-12-31$163,933
Participant contributions at end of year2021-12-31$6,600
Participant contributions at beginning of year2021-12-31$57,287
Assets. Other investments not covered elsewhere at end of year2021-12-31$2,909,131
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$1,951,248
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$154,936
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$1,164
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$2,012
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$50
Other income not declared elsewhere2021-12-31$408
Administrative expenses (other) incurred2021-12-31$8,402
Total non interest bearing cash at end of year2021-12-31$2,237
Total non interest bearing cash at beginning of year2021-12-31$3,332
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,456,943
Value of net assets at end of year (total assets less liabilities)2021-12-31$13,577,690
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$12,120,747
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$51,087
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$9,259,661
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$8,185,032
Interest on participant loans2021-12-31$7,598
Income. Interest from corporate debt instruments2021-12-31$1,204
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$317,458
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$509,616
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$509,616
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$65
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$907,045
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31Yes
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$485,886
Employer contributions (assets) at end of year2021-12-31$88,521
Employer contributions (assets) at beginning of year2021-12-31$151,512
Income. Dividends from common stock2021-12-31$235,605
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,141,857
Asset. Corporate debt instrument debt (other) at end of year2021-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2021-12-31$19,355
Contract administrator fees2021-12-31$21,538
Assets. Corporate common stocks other than exployer securities at end of year2021-12-31$885,796
Assets. Corporate common stocks other than exployer securities at beginning of year2021-12-31$1,077,470
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Aggregate proceeds on sale of assets2021-12-31$1,214,254
Aggregate carrying amount (costs) on sale of assets2021-12-31$1,266,771
Opinion of an independent qualified public accountant for this plan2021-12-31Disclaimer
Accountancy firm name2021-12-31JONES & ROTH
Accountancy firm EIN2021-12-31930819646
2020 : CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$466,069
Total unrealized appreciation/depreciation of assets2020-12-31$466,069
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$50
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$2,431,754
Total loss/gain on sale of assets2020-12-31$-160,641
Total of all expenses incurred2020-12-31$389,556
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$323,991
Value of total corrective distributions2020-12-31$1,924
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,141,497
Value of total assets at end of year2020-12-31$12,120,797
Value of total assets at beginning of year2020-12-31$10,078,549
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$63,641
Total interest from all sources2020-12-31$17,251
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$163,565
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$500,000
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$365,416
Participant contributions at end of year2020-12-31$163,933
Participant contributions at beginning of year2020-12-31$148,148
Participant contributions at end of year2020-12-31$57,287
Participant contributions at beginning of year2020-12-31$36,998
Assets. Other investments not covered elsewhere at end of year2020-12-31$1,951,248
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$1,516,826
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$295,694
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$2,012
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$1,474
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$50
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$0
Other income not declared elsewhere2020-12-31$2,505
Administrative expenses (other) incurred2020-12-31$4,575
Total non interest bearing cash at end of year2020-12-31$3,332
Total non interest bearing cash at beginning of year2020-12-31$2,836
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$2,042,198
Value of net assets at end of year (total assets less liabilities)2020-12-31$12,120,747
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$10,078,549
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
Investment advisory and management fees2020-12-31$43,481
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$8,185,032
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$6,890,875
Interest on participant loans2020-12-31$8,188
Income. Interest from corporate debt instruments2020-12-31$7,963
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$509,616
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$412,867
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$412,867
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$1,100
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$801,508
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
Contributions received in cash from employer2020-12-31$480,387
Employer contributions (assets) at end of year2020-12-31$151,512
Employer contributions (assets) at beginning of year2020-12-31$152,468
Income. Dividends from common stock2020-12-31$163,565
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$323,991
Asset. Corporate debt instrument debt (other) at end of year2020-12-31$19,355
Asset. Corporate debt instrument debt (other) at beginning of year2020-12-31$18,900
Contract administrator fees2020-12-31$15,585
Assets. Corporate common stocks other than exployer securities at end of year2020-12-31$1,077,470
Assets. Corporate common stocks other than exployer securities at beginning of year2020-12-31$897,157
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
Aggregate proceeds on sale of assets2020-12-31$724,606
Aggregate carrying amount (costs) on sale of assets2020-12-31$885,247
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31JONES & ROTH
Accountancy firm EIN2020-12-31930819646
2019 : CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$393,728
Total unrealized appreciation/depreciation of assets2019-12-31$393,728
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$2,555,967
Total loss/gain on sale of assets2019-12-31$6,290
Total of all expenses incurred2019-12-31$2,279,953
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$2,229,900
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$903,219
Value of total assets at end of year2019-12-31$10,078,549
Value of total assets at beginning of year2019-12-31$9,802,535
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$50,053
Total interest from all sources2019-12-31$17,000
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$184,716
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
Value of fidelity bond cover2019-12-31$500,000
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
Contributions received from participants2019-12-31$370,477
Participant contributions at end of year2019-12-31$148,148
Participant contributions at beginning of year2019-12-31$176,418
Participant contributions at end of year2019-12-31$36,998
Participant contributions at beginning of year2019-12-31$23,633
Assets. Other investments not covered elsewhere at end of year2019-12-31$1,516,826
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$1,368,790
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$70,992
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$1,474
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$2,191
Other income not declared elsewhere2019-12-31$38
Administrative expenses (other) incurred2019-12-31$5,568
Total non interest bearing cash at end of year2019-12-31$2,836
Total non interest bearing cash at beginning of year2019-12-31$25,936
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$276,014
Value of net assets at end of year (total assets less liabilities)2019-12-31$10,078,549
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$9,802,535
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 leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$41,937
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$6,890,875
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$6,940,945
Interest on participant loans2019-12-31$8,543
Income. Interest from corporate debt instruments2019-12-31$1,116
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$412,867
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$604,748
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$604,748
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$7,341
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$1,050,976
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 contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$461,750
Employer contributions (assets) at end of year2019-12-31$152,468
Employer contributions (assets) at beginning of year2019-12-31$125,831
Income. Dividends from common stock2019-12-31$184,716
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$2,229,900
Asset. Corporate debt instrument debt (other) at end of year2019-12-31$18,900
Asset. Corporate debt instrument debt (other) at beginning of year2019-12-31$0
Contract administrator fees2019-12-31$2,548
Assets. Corporate common stocks other than exployer securities at end of year2019-12-31$897,157
Assets. Corporate common stocks other than exployer securities at beginning of year2019-12-31$534,043
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
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Aggregate proceeds on sale of assets2019-12-31$421,506
Aggregate carrying amount (costs) on sale of assets2019-12-31$415,216
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31JONES & ROTH
Accountancy firm EIN2019-12-31930819646
2018 : CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-12-31$-115,273
Total unrealized appreciation/depreciation of assets2018-12-31$-115,273
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$318,842
Total loss/gain on sale of assets2018-12-31$-58,181
Total of all expenses incurred2018-12-31$642,377
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$583,711
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$840,818
Value of total assets at end of year2018-12-31$9,802,535
Value of total assets at beginning of year2018-12-31$10,126,070
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$58,666
Total interest from all sources2018-12-31$13,181
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$226,763
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$389,893
Participant contributions at end of year2018-12-31$176,418
Participant contributions at beginning of year2018-12-31$165,085
Participant contributions at end of year2018-12-31$23,633
Participant contributions at beginning of year2018-12-31$43,877
Assets. Other investments not covered elsewhere at end of year2018-12-31$1,368,790
Assets. Other investments not covered elsewhere at beginning of year2018-12-31$1,663,583
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$17,808
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$2,191
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$1,045
Other income not declared elsewhere2018-12-31$399
Administrative expenses (other) incurred2018-12-31$6,792
Total non interest bearing cash at end of year2018-12-31$25,936
Total non interest bearing cash at beginning of year2018-12-31$8,591
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-323,535
Value of net assets at end of year (total assets less liabilities)2018-12-31$9,802,535
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$10,126,070
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$51,702
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$6,940,945
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$7,218,038
Interest on participant loans2018-12-31$8,711
Income. Interest from corporate debt instruments2018-12-31$181
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$604,748
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$252,426
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$252,426
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$4,289
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-588,865
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$433,117
Employer contributions (assets) at end of year2018-12-31$125,831
Employer contributions (assets) at beginning of year2018-12-31$212,357
Income. Dividends from common stock2018-12-31$226,763
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$583,711
Contract administrator fees2018-12-31$172
Assets. Corporate common stocks other than exployer securities at end of year2018-12-31$534,043
Assets. Corporate common stocks other than exployer securities at beginning of year2018-12-31$561,068
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Aggregate proceeds on sale of assets2018-12-31$1,046,841
Aggregate carrying amount (costs) on sale of assets2018-12-31$1,105,022
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31JONES & ROTH
Accountancy firm EIN2018-12-31930819646
2017 : CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-12-31$170,559
Total unrealized appreciation/depreciation of assets2017-12-31$170,559
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$2,069,312
Total loss/gain on sale of assets2017-12-31$15,132
Total of all expenses incurred2017-12-31$126,868
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$75,697
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$888,021
Value of total assets at end of year2017-12-31$10,126,070
Value of total assets at beginning of year2017-12-31$8,183,626
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$51,171
Total interest from all sources2017-12-31$9,162
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$191,266
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$360,223
Participant contributions at end of year2017-12-31$165,085
Participant contributions at beginning of year2017-12-31$169,662
Participant contributions at end of year2017-12-31$43,877
Participant contributions at beginning of year2017-12-31$49,907
Assets. Other investments not covered elsewhere at end of year2017-12-31$1,663,583
Assets. Other investments not covered elsewhere at beginning of year2017-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$65,740
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$1,045
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$439
Other income not declared elsewhere2017-12-31$1,661
Administrative expenses (other) incurred2017-12-31$2,520
Total non interest bearing cash at end of year2017-12-31$8,591
Total non interest bearing cash at beginning of year2017-12-31$7,311
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$1,942,444
Value of net assets at end of year (total assets less liabilities)2017-12-31$10,126,070
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$8,183,626
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$41,846
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$7,218,038
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$6,448,637
Interest on participant loans2017-12-31$7,431
Income. Interest from corporate debt instruments2017-12-31$275
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$252,426
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$241,071
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$241,071
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$1,456
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$793,511
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31Yes
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$462,058
Employer contributions (assets) at end of year2017-12-31$212,357
Employer contributions (assets) at beginning of year2017-12-31$352,862
Income. Dividends from common stock2017-12-31$191,266
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$75,697
Contract administrator fees2017-12-31$6,805
Assets. Corporate common stocks other than exployer securities at end of year2017-12-31$561,068
Assets. Corporate common stocks other than exployer securities at beginning of year2017-12-31$913,737
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Aggregate proceeds on sale of assets2017-12-31$15,132
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31JONES & ROTH
Accountancy firm EIN2017-12-31930819646
2008 : CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2008 401k financial data
Total plan liabilities at beginning of year2008-12-31$32,191
Total income from all sources2008-12-31$-1,700,480
Expenses. Total of all expenses incurred2008-12-31$648,930
Benefits paid (including direct rollovers)2008-12-31$599,109
Total plan assets at end of year2008-12-31$5,908,994
Total plan assets at beginning of year2008-12-31$8,290,595
Value of fidelity bond covering the plan2008-12-31$500,000
Total contributions received or receivable from participants2008-12-31$159,234
Expenses. Other expenses not covered elsewhere2008-12-31$49,821
Contributions received from other sources (not participants or employers)2008-12-31$9,015
Other income received2008-12-31$-2,152,931
Net income (gross income less expenses)2008-12-31$-2,349,410
Net plan assets at end of year (total assets less liabilities)2008-12-31$5,908,994
Net plan assets at beginning of year (total assets less liabilities)2008-12-31$8,258,404
Assets. Value of participant loans2008-12-31$49,076
Total contributions received or receivable from employer(s)2008-12-31$284,202

Form 5500 Responses for CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN

2022: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 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 filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 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 – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 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 – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: CENTRAL OREGON PEDIATRIC ASSOCIATES 401(K) PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number14285
Policy instance 1
Insurance contract or identification number14285
Number of Individuals Covered166
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $9,283
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
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 fees9283
Additional information about fees paid to insurance brokerTPA COMPENSATION & TPA FEES
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number14285
Policy instance 1
Insurance contract or identification number14285
Number of Individuals Covered155
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $10,628
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
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 fees10628
Additional information about fees paid to insurance brokerTPA COMPENSATION & TPA FEES
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number14285
Policy instance 1
Insurance contract or identification number14285
Number of Individuals Covered142
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 $6,169
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
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 fees6169
Additional information about fees paid to insurance brokerTPA COMPENSATION & TPA FEES
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number14285
Policy instance 1
Insurance contract or identification number14285
Number of Individuals Covered120
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 $7,719
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
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 fees7719
Additional information about fees paid to insurance brokerTPA COMPENSATION & TPA FEES
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number14285
Policy instance 1
Insurance contract or identification number14285
Number of Individuals Covered113
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $8,012
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
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
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees8012
Additional information about fees paid to insurance brokerTPA COMPENSATION & TPA FEES
Insurance broker organization code?5
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number14285
Policy instance 1
Insurance contract or identification number14285
Number of Individuals Covered119
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,128
Total amount of fees paid to insurance companyUSD $3,515
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
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
Commission paid to Insurance BrokerUSD $7,128
Insurance broker organization code?7
Amount paid for insurance broker fees3515
Additional information about fees paid to insurance brokerTPA COMPENSATION & TPA FEES
Insurance broker namePENSION PLANNERS NORTHWEST
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number14285
Policy instance 1
Insurance contract or identification number14285
Number of Individuals Covered44
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $3,478
Total amount of fees paid to insurance companyUSD $560
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
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
Commission paid to Insurance BrokerUSD $3,478
Insurance broker organization code?4
Amount paid for insurance broker fees560
Additional information about fees paid to insurance brokerTPA COMPENSATION
Insurance broker nameNATIONAL ASSOCAITES, INC NW

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