401k Plan data: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN plan

PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 401k Plan overview

Plan Name	PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN
Plan identification number	005

PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

PACIFIC EYE CENTER, INC. has sponsored the creation of one or more 401k plans.

Company Name: PACIFIC EYE CENTER, INC.

Employer identification number (EIN): 990284158

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

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
005 2022-01-01
005 2021-01-01
005 2020-01-01
005 2019-01-01
005 2018-01-01
005 2017-01-01 LARRY SHERRER
005 2016-01-01 LARRY SHERRER
005 2015-01-01 LARRY SHERRER
005 2014-01-01 LARRY SHERRER
005 2013-01-01 LARRY SHERRER
005 2012-01-01 LARRY SHERRER
005 2011-01-01 LARRY SHERRER
005 2010-01-01 LARRY SHERRER

Plan Statistics for PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN

Measure Date Value
2022: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 19
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 11
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 9
Total of all active and inactive participants 2022-01-01 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 20
Number of participants with account balances 2022-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 0
2021: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 7
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 12
Total of all active and inactive participants 2021-01-01 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 19
Number of participants with account balances 2021-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 2
2020: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 17
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 8
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 11
Total of all active and inactive participants 2020-01-01 19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 19
Number of participants with account balances 2020-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 18
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 6
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 11
Total of all active and inactive participants 2019-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 17
Number of participants with account balances 2019-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 1
2018: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 8
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 10
Total of all active and inactive participants 2018-01-01 18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 18
Number of participants with account balances 2018-01-01 18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 4
2017: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 8
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 5
Total of all active and inactive participants 2017-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 13
Number of participants with account balances 2017-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 7
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 8
Total of all active and inactive participants 2016-01-01 15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 15
Number of participants with account balances 2016-01-01 15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 5
2015: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 11
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 3
Total of all active and inactive participants 2015-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 14
Number of participants with account balances 2015-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 1
2014: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 11
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 2
Total of all active and inactive participants 2014-01-01 13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 13
Number of participants with account balances 2014-01-01 13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 12
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 2
Total of all active and inactive participants 2013-01-01 14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 14
Number of participants with account balances 2013-01-01 14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2012: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 12
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 0
Total of all active and inactive participants 2012-01-01 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 12
Number of participants with account balances 2012-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 2
2011: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 11
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 12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 12
Number of participants with account balances 2011-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 9
Number of retired or separated participants receiving benefits 2010-01-01 1
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 10
Number of participants with account balances 2010-01-01 10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 1

Measure	Date	Value
2022: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	19
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	11
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	9
Total of all active and inactive participants	2022-01-01	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	20
Number of participants with account balances	2022-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	0
2021: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	7
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	12
Total of all active and inactive participants	2021-01-01	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	19
Number of participants with account balances	2021-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	2
2020: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	17
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	8
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	11
Total of all active and inactive participants	2020-01-01	19
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	19
Number of participants with account balances	2020-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	18
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	6
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	11
Total of all active and inactive participants	2019-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	17
Number of participants with account balances	2019-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	1
2018: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	8
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	10
Total of all active and inactive participants	2018-01-01	18
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	18
Number of participants with account balances	2018-01-01	18
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	4
2017: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	8
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	5
Total of all active and inactive participants	2017-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	13
Number of participants with account balances	2017-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	7
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	8
Total of all active and inactive participants	2016-01-01	15
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	15
Number of participants with account balances	2016-01-01	15
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	5
2015: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	11
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	3
Total of all active and inactive participants	2015-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	14
Number of participants with account balances	2015-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	1
2014: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	11
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	2
Total of all active and inactive participants	2014-01-01	13
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	13
Number of participants with account balances	2014-01-01	13
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	12
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	2
Total of all active and inactive participants	2013-01-01	14
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	14
Number of participants with account balances	2013-01-01	14
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2012: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	12
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	0
Total of all active and inactive participants	2012-01-01	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	12
Number of participants with account balances	2012-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	2
2011: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	11
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	12
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	12
Number of participants with account balances	2011-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	9
Number of retired or separated participants receiving benefits	2010-01-01	1
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	10
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	10
Number of participants with account balances	2010-01-01	10
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	1

Financial Data on PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN

Measure	Date	Value
2022 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2022 401k financial data
Total plan liabilities at end of year	2022-12-31	$0
Total plan liabilities at beginning of year	2022-12-31	$0
Total income from all sources	2022-12-31	$-60,030
Expenses. Total of all expenses incurred	2022-12-31	$6,182
Benefits paid (including direct rollovers)	2022-12-31	$2,743
Total plan assets at end of year	2022-12-31	$1,071,054
Total plan assets at beginning of year	2022-12-31	$1,137,266
Value of fidelity bond covering the plan	2022-12-31	$250,000
Total contributions received or receivable from participants	2022-12-31	$52,272
Other income received	2022-12-31	$-203,814
Net income (gross income less expenses)	2022-12-31	$-66,212
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$1,071,054
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$1,137,266
Assets. Value of assets in partnership/joint-venture interests	2022-12-31	$25,000
Total contributions received or receivable from employer(s)	2022-12-31	$91,512
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$3,439
2021 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2021 401k financial data
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$385,908
Expenses. Total of all expenses incurred	2021-12-31	$1,135,926
Benefits paid (including direct rollovers)	2021-12-31	$1,135,851
Total plan assets at end of year	2021-12-31	$1,137,266
Total plan assets at beginning of year	2021-12-31	$1,887,284
Value of fidelity bond covering the plan	2021-12-31	$135,000
Total contributions received or receivable from participants	2021-12-31	$49,230
Other income received	2021-12-31	$245,552
Net income (gross income less expenses)	2021-12-31	$-750,018
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$1,137,266
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$1,887,284
Assets. Value of assets in partnership/joint-venture interests	2021-12-31	$25,000
Total contributions received or receivable from employer(s)	2021-12-31	$91,126
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$75
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2021-12-31	$0
2020 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2020 401k financial data
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$348,674
Expenses. Total of all expenses incurred	2020-12-31	$0
Total plan assets at end of year	2020-12-31	$1,887,284
Total plan assets at beginning of year	2020-12-31	$1,538,610
Value of fidelity bond covering the plan	2020-12-31	$135,000
Total contributions received or receivable from participants	2020-12-31	$53,861
Other income received	2020-12-31	$215,148
Net income (gross income less expenses)	2020-12-31	$348,674
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$1,887,284
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$1,538,610
Assets. Value of assets in partnership/joint-venture interests	2020-12-31	$25,000
Total contributions received or receivable from employer(s)	2020-12-31	$79,665
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-12-31	$0
2019 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2019 401k financial data
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$235,449
Expenses. Total of all expenses incurred	2019-12-31	$389
Benefits paid (including direct rollovers)	2019-12-31	$389
Total plan assets at end of year	2019-12-31	$1,538,610
Total plan assets at beginning of year	2019-12-31	$1,303,550
Value of fidelity bond covering the plan	2019-12-31	$135,000
Total contributions received or receivable from participants	2019-12-31	$32,328
Other income received	2019-12-31	$140,727
Net income (gross income less expenses)	2019-12-31	$235,060
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$1,538,610
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$1,303,550
Assets. Value of assets in partnership/joint-venture interests	2019-12-31	$25,000
Total contributions received or receivable from employer(s)	2019-12-31	$62,394
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2018 401k financial data
Total plan liabilities at end of year	2018-12-31	$0
Total plan liabilities at beginning of year	2018-12-31	$0
Total income from all sources	2018-12-31	$30,339
Expenses. Total of all expenses incurred	2018-12-31	$8,222
Benefits paid (including direct rollovers)	2018-12-31	$8,197
Total plan assets at end of year	2018-12-31	$1,303,550
Total plan assets at beginning of year	2018-12-31	$1,281,433
Value of fidelity bond covering the plan	2018-12-31	$135,000
Total contributions received or receivable from participants	2018-12-31	$50,786
Other income received	2018-12-31	$-86,162
Net income (gross income less expenses)	2018-12-31	$22,117
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$1,303,550
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$1,281,433
Assets. Value of assets in partnership/joint-venture interests	2018-12-31	$131,541
Total contributions received or receivable from employer(s)	2018-12-31	$65,715
Expenses. Administrative service providers (salaries,fees and commissions)	2018-12-31	$25
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2017 401k financial data
Total plan liabilities at end of year	2017-12-31	$0
Total plan liabilities at beginning of year	2017-12-31	$0
Total income from all sources	2017-12-31	$241,951
Expenses. Total of all expenses incurred	2017-12-31	$3,223
Benefits paid (including direct rollovers)	2017-12-31	$440
Total plan assets at end of year	2017-12-31	$1,281,433
Total plan assets at beginning of year	2017-12-31	$1,042,705
Value of fidelity bond covering the plan	2017-12-31	$135,000
Total contributions received or receivable from participants	2017-12-31	$57,236
Other income received	2017-12-31	$129,723
Net income (gross income less expenses)	2017-12-31	$238,728
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$1,281,433
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$1,042,705
Assets. Value of assets in partnership/joint-venture interests	2017-12-31	$131,541
Total contributions received or receivable from employer(s)	2017-12-31	$54,992
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$2,783
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$170,754
Expenses. Total of all expenses incurred	2016-12-31	$25,991
Benefits paid (including direct rollovers)	2016-12-31	$21,279
Total plan assets at end of year	2016-12-31	$1,042,705
Total plan assets at beginning of year	2016-12-31	$897,942
Value of fidelity bond covering the plan	2016-12-31	$135,000
Total contributions received or receivable from participants	2016-12-31	$60,701
Other income received	2016-12-31	$44,245
Net income (gross income less expenses)	2016-12-31	$144,763
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,042,705
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$897,942
Assets. Value of assets in partnership/joint-venture interests	2016-12-31	$131,541
Total contributions received or receivable from employer(s)	2016-12-31	$65,808
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$4,712
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$129,302
Expenses. Total of all expenses incurred	2015-12-31	$13,660
Benefits paid (including direct rollovers)	2015-12-31	$10,896
Total plan assets at end of year	2015-12-31	$897,942
Total plan assets at beginning of year	2015-12-31	$782,300
Value of fidelity bond covering the plan	2015-12-31	$135,000
Total contributions received or receivable from participants	2015-12-31	$62,619
Other income received	2015-12-31	$-3,321
Net income (gross income less expenses)	2015-12-31	$115,642
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$897,942
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$782,300
Assets. Value of assets in partnership/joint-venture interests	2015-12-31	$131,541
Total contributions received or receivable from employer(s)	2015-12-31	$70,004
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$2,764
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$157,896
Expenses. Total of all expenses incurred	2014-12-31	$2,707
Benefits paid (including direct rollovers)	2014-12-31	$374
Total plan assets at end of year	2014-12-31	$782,300
Total plan assets at beginning of year	2014-12-31	$627,111
Value of fidelity bond covering the plan	2014-12-31	$135,000
Total contributions received or receivable from participants	2014-12-31	$60,188
Other income received	2014-12-31	$28,394
Net income (gross income less expenses)	2014-12-31	$155,189
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$782,300
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$627,111
Assets. Value of assets in partnership/joint-venture interests	2014-12-31	$131,541
Total contributions received or receivable from employer(s)	2014-12-31	$69,314
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$2,333
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$180,469
Expenses. Total of all expenses incurred	2013-12-31	$3,129
Benefits paid (including direct rollovers)	2013-12-31	$1,420
Total plan assets at end of year	2013-12-31	$627,111
Total plan assets at beginning of year	2013-12-31	$449,771
Value of fidelity bond covering the plan	2013-12-31	$135,000
Total contributions received or receivable from participants	2013-12-31	$61,813
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$48,227
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$177,340
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$627,111
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$449,771
Assets. Value of assets in partnership/joint-venture interests	2013-12-31	$131,541
Total contributions received or receivable from employer(s)	2013-12-31	$70,429
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$1,709
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$136,504
Expenses. Total of all expenses incurred	2012-12-31	$20,779
Benefits paid (including direct rollovers)	2012-12-31	$19,681
Total plan assets at end of year	2012-12-31	$449,771
Total plan assets at beginning of year	2012-12-31	$334,046
Value of fidelity bond covering the plan	2012-12-31	$750,000
Total contributions received or receivable from participants	2012-12-31	$49,247
Expenses. Other expenses not covered elsewhere	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$24,324
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$115,725
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$449,771
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$334,046
Assets. Value of assets in partnership/joint-venture interests	2012-12-31	$131,541
Total contributions received or receivable from employer(s)	2012-12-31	$62,933
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$1,098
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2011 401k financial data
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$110,023
Expenses. Total of all expenses incurred	2011-12-31	$629,642
Benefits paid (including direct rollovers)	2011-12-31	$628,880
Total plan assets at end of year	2011-12-31	$334,046
Total plan assets at beginning of year	2011-12-31	$853,665
Value of fidelity bond covering the plan	2011-12-31	$750,000
Total contributions received or receivable from participants	2011-12-31	$42,056
Other income received	2011-12-31	$7,862
Net income (gross income less expenses)	2011-12-31	$-519,619
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$334,046
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$853,665
Assets. Value of assets in partnership/joint-venture interests	2011-12-31	$131,541
Total contributions received or receivable from employer(s)	2011-12-31	$60,105
Value of certain deemed distributions of participant loans	2011-12-31	$762
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$853,665
Expenses. Total of all expenses incurred	2010-12-31	$0
Benefits paid (including direct rollovers)	2010-12-31	$0
Total plan assets at end of year	2010-12-31	$853,665
Total plan assets at beginning of year	2010-12-31	$0
Value of fidelity bond covering the plan	2010-12-31	$750,000
Total contributions received or receivable from participants	2010-12-31	$39,229
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$757,022
Other income received	2010-12-31	$3,856
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$853,665
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$853,665
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$0
Assets. Value of assets in partnership/joint-venture interests	2010-12-31	$131,541
Total contributions received or receivable from employer(s)	2010-12-31	$53,558
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$0

Form 5500 Responses for PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN

2022: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS 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 – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS 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 – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS 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 – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS 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 – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS 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 – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: PACIFIC EYE CENTER, INC. 401(K) RETIREMENT SAVINGS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	First time form 5500 has been submitted	Yes
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	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

99217

Policy instance

Insurance contract or identification number	99217
Number of Individuals Covered	19
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,809
Total amount of fees paid to insurance company	USD $0
Commission paid to Insurance Broker	USD $4,809
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3

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

Policy contract number

99217

Policy instance

Insurance contract or identification number	99217
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $9,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,753
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3

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

Policy contract number

99217

Policy instance

Insurance contract or identification number	99217
Number of Individuals Covered	18
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $7,412
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	7412
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3

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

Policy contract number

99217

Policy instance

Insurance contract or identification number	99217
Number of Individuals Covered	17
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,389
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,389
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3

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

Policy contract number

99217

Policy instance

Insurance contract or identification number	99217
Number of Individuals Covered	13
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,674
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,674
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3

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

Policy contract number

99217

Policy instance

Insurance contract or identification number	99217
Number of Individuals Covered	12
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,742
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,742
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	COMMISSION
Insurance broker organization code?	3
Insurance broker name	AMERIPRISE FINANCIAL SERVICES

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Company Name:	PACIFIC EYE CENTER, INC.
Employer identification number (EIN):	990284158
NAIC Classification:	621111
NAIC Description:	Offices of Physicians (except Mental Health Specialists)