ROBERT F CHORAK DDS PC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan DR. ROBERT CHORAK 401(K) PLAN
401k plan membership statisitcs for DR. ROBERT CHORAK 401(K) PLAN
| Measure | Date | Value |
|---|
| 2019: DR. ROBERT CHORAK 401(K) PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 0 |
| 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 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 0 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2019-01-01 | 0 |
| Total participants | 2019-01-01 | 0 |
| Number of participants with account balances | 2019-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2019-01-01 | 0 |
| 2018: DR. ROBERT CHORAK 401(K) PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 2 |
| 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 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 0 |
| Total participants | 2018-01-01 | 2 |
| Number of participants with account balances | 2018-01-01 | 2 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-01-01 | 0 |
| 2017: DR. ROBERT CHORAK 401(K) PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 2 |
| 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 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-01-01 | 0 |
| Total participants | 2017-01-01 | 2 |
| Number of participants with account balances | 2017-01-01 | 2 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-01-01 | 0 |
| 2016: DR. ROBERT CHORAK 401(K) PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 2 |
| 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 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-01-01 | 0 |
| Total participants | 2016-01-01 | 2 |
| Number of participants with account balances | 2016-01-01 | 2 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-01-01 | 0 |
| 2015: DR. ROBERT CHORAK 401(K) PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 2 |
| 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 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2015-01-01 | 0 |
| Total participants | 2015-01-01 | 2 |
| Number of participants with account balances | 2015-01-01 | 2 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2015-01-01 | 0 |
| 2014: DR. ROBERT CHORAK 401(K) PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 2 |
| 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 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-01-01 | 0 |
| Total participants | 2014-01-01 | 2 |
| Number of participants with account balances | 2014-01-01 | 2 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-01-01 | 0 |
| 2013: DR. ROBERT CHORAK 401(K) PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 2 |
| 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 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 0 |
| Total participants | 2013-01-01 | 2 |
| Number of participants with account balances | 2013-01-01 | 2 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-01-01 | 0 |
| 2012: DR. ROBERT CHORAK 401(K) PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 2 |
| 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 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 0 |
| Total participants | 2012-01-01 | 2 |
| Number of participants with account balances | 2012-01-01 | 2 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-01-01 | 0 |
| 2011: DR. ROBERT CHORAK 401(K) PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 2 |
| 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 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-01-01 | 0 |
| Total participants | 2011-01-01 | 2 |
| Number of participants with account balances | 2011-01-01 | 2 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-01-01 | 0 |
| 2009: DR. ROBERT CHORAK 401(K) PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 2 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 2 |
| Number of participants with account balances | 2009-01-01 | 2 |
| Measure | Date | Value |
|---|
| 2019 : DR. ROBERT CHORAK 401(K) PLAN 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $78,628 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $877,976 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $876,383 |
| Total plan assets at end of year | 2019-12-31 | $0 |
| Total plan assets at beginning of year | 2019-12-31 | $799,348 |
| Other income received | 2019-12-31 | $78,628 |
| Net income (gross income less expenses) | 2019-12-31 | $-799,348 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $799,348 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $1,593 |
| 2018 : DR. ROBERT CHORAK 401(K) PLAN 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $2,565 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $2,136 |
| Total plan assets at end of year | 2018-12-31 | $799,348 |
| Total plan assets at beginning of year | 2018-12-31 | $798,919 |
| Value of fidelity bond covering the plan | 2018-12-31 | $75,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $24,000 |
| Other income received | 2018-12-31 | $-35,435 |
| Net income (gross income less expenses) | 2018-12-31 | $429 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $799,348 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $798,919 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $14,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $2,136 |
| 2017 : DR. ROBERT CHORAK 401(K) PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $96,400 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $1,450 |
| Total plan assets at end of year | 2017-12-31 | $798,919 |
| Total plan assets at beginning of year | 2017-12-31 | $703,969 |
| Value of fidelity bond covering the plan | 2017-12-31 | $75,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $24,000 |
| Other income received | 2017-12-31 | $58,370 |
| Net income (gross income less expenses) | 2017-12-31 | $94,950 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $798,919 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $703,969 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $14,030 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $1,450 |
| 2016 : DR. ROBERT CHORAK 401(K) PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $50,880 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $462 |
| Total plan assets at end of year | 2016-12-31 | $703,969 |
| Total plan assets at beginning of year | 2016-12-31 | $653,551 |
| Value of fidelity bond covering the plan | 2016-12-31 | $75,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $24,000 |
| Other income received | 2016-12-31 | $12,589 |
| Net income (gross income less expenses) | 2016-12-31 | $50,418 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $703,969 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $653,551 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $14,291 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $462 |
| 2015 : DR. ROBERT CHORAK 401(K) PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $49,641 |
| Total plan assets at end of year | 2015-12-31 | $653,551 |
| Total plan assets at beginning of year | 2015-12-31 | $603,910 |
| Value of fidelity bond covering the plan | 2015-12-31 | $75,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $24,000 |
| Other income received | 2015-12-31 | $7,357 |
| Net income (gross income less expenses) | 2015-12-31 | $49,641 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $653,551 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $603,910 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $18,284 |
| 2014 : DR. ROBERT CHORAK 401(K) PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $36,929 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $2,904 |
| Total plan assets at end of year | 2014-12-31 | $603,910 |
| Total plan assets at beginning of year | 2014-12-31 | $569,885 |
| Value of fidelity bond covering the plan | 2014-12-31 | $75,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $23,000 |
| Other income received | 2014-12-31 | $10,131 |
| Net income (gross income less expenses) | 2014-12-31 | $34,025 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $603,910 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $569,885 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $3,798 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $2,904 |
| 2013 : DR. ROBERT CHORAK 401(K) PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $36,194 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $2,718 |
| Total plan assets at end of year | 2013-12-31 | $569,885 |
| Total plan assets at beginning of year | 2013-12-31 | $536,409 |
| Value of fidelity bond covering the plan | 2013-12-31 | $50,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $23,000 |
| Other income received | 2013-12-31 | $9,568 |
| Net income (gross income less expenses) | 2013-12-31 | $33,476 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $569,885 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $536,409 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $3,626 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $2,718 |
| 2012 : DR. ROBERT CHORAK 401(K) PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $86,718 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $2,403 |
| Total plan assets at end of year | 2012-12-31 | $536,409 |
| Total plan assets at beginning of year | 2012-12-31 | $452,094 |
| Value of fidelity bond covering the plan | 2012-12-31 | $50,000 |
| Total contributions received or receivable from participants | 2012-12-31 | $22,500 |
| Other income received | 2012-12-31 | $46,924 |
| Net income (gross income less expenses) | 2012-12-31 | $84,315 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $536,409 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $452,094 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $17,294 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $2,403 |
| 2011 : DR. ROBERT CHORAK 401(K) PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $44,240 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $2,042 |
| Total plan assets at end of year | 2011-12-31 | $452,094 |
| Total plan assets at beginning of year | 2011-12-31 | $409,896 |
| Value of fidelity bond covering the plan | 2011-12-31 | $50,000 |
| Total contributions received or receivable from participants | 2011-12-31 | $19,200 |
| Other income received | 2011-12-31 | $5,031 |
| Net income (gross income less expenses) | 2011-12-31 | $42,198 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $452,094 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $409,896 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $20,009 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-12-31 | $2,042 |
| 2010 : DR. ROBERT CHORAK 401(K) PLAN 2010 401k financial data |
|---|
| Total income from all sources | 2010-12-31 | $81,426 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $1,752 |
| Total plan assets at end of year | 2010-12-31 | $409,896 |
| Total plan assets at beginning of year | 2010-12-31 | $330,222 |
| Value of fidelity bond covering the plan | 2010-12-31 | $50,000 |
| Total contributions received or receivable from participants | 2010-12-31 | $22,000 |
| Other income received | 2010-12-31 | $39,426 |
| Net income (gross income less expenses) | 2010-12-31 | $79,674 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $409,896 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $330,222 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $20,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-12-31 | $1,752 |
| 2019: DR. ROBERT CHORAK 401(K) PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | This submission is the final filing | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: DR. ROBERT CHORAK 401(K) PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: DR. ROBERT CHORAK 401(K) PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: DR. ROBERT CHORAK 401(K) PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: DR. ROBERT CHORAK 401(K) PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: DR. ROBERT CHORAK 401(K) PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: DR. ROBERT CHORAK 401(K) PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: DR. ROBERT CHORAK 401(K) PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: DR. ROBERT CHORAK 401(K) PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: DR. ROBERT CHORAK 401(K) PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 ) |
| Policy contract number | 334708-01 |
| Policy instance | 1 |
| Insurance contract or identification number | 334708-01 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for group deferred annuity? | Yes | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 ) |
| Policy contract number | 334708-01 |
| Policy instance | 1 |
| Insurance contract or identification number | 334708-01 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $508 | | Are there contracts with allocated funds for group deferred annuity? | Yes | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $508 | | Insurance broker organization code? | 3 |
|
| GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 ) |
| Policy contract number | 334708-01 |
| Policy instance | 1 |
| Insurance contract or identification number | 334708-01 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,578 | | Are there contracts with allocated funds for group deferred annuity? | Yes | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,578 | | Insurance broker organization code? | 3 | | Insurance broker name | LARRY EGGERS, AMERIPRISE FIN |
|
| GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 ) |
| Policy contract number | 334708-01 |
| Policy instance | 1 |
| Insurance contract or identification number | 334708-01 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,076 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,827 | | Insurance broker organization code? | 3 | | Insurance broker name | LARRY EGGERS, USBANCORP |
|
| GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 ) |
| Policy contract number | 334708-01 |
| Policy instance | 1 |
| Insurance contract or identification number | 334708-01 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,904 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,904 | | Insurance broker organization code? | 3 | | Insurance broker name | LARRY EGGERS, US BANCORP INV., INC. |
|
| GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 ) |
| Policy contract number | 334708-01 |
| Policy instance | 1 |
| Insurance contract or identification number | 334708-01 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,718 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,718 | | Insurance broker organization code? | 3 | | Insurance broker name | LARRY EGGERS, US BANCORP INV., INC. |
|
| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 85669 |
| Policy instance | 1 |
| Insurance contract or identification number | 85669 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-11-05 | | Total amount of commissions paid to insurance broker | USD $2,190 | | Are there contracts with allocated funds for group deferred annuity? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,190 | | Insurance broker organization code? | 3 | | Insurance broker name | EGGERS FINANCIAL GROUP |
|
| GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 ) |
| Policy contract number | 334708-01 |
| Policy instance | 2 |
| Insurance contract or identification number | 334708-01 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $213 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $213 | | Insurance broker organization code? | 3 | | Insurance broker name | LARRY EGGERS, US BANCORP INV., INC. |
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| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 85669 |
| Policy instance | 1 |
| Insurance contract or identification number | 85669 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,088 | | Are there contracts with allocated funds for group deferred annuity? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 ) |
| Policy contract number | 85669 |
| Policy instance | 1 |
| Insurance contract or identification number | 85669 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,711 | | Are there contracts with allocated funds for group deferred annuity? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,175 | | Insurance broker organization code? | 4 | | Insurance broker name | CG RISK MANAGEMENT, L.L.C. |
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