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GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 401k Plan overview

Plan NameGENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN
Plan identification number 007

GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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(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.
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • 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

GENESIS HEALTHCARE SYSTEM has sponsored the creation of one or more 401k plans.

Company Name:GENESIS HEALTHCARE SYSTEM
Employer identification number (EIN):311480941
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about GENESIS HEALTHCARE SYSTEM

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1996-09-20
Company Identification Number: 953587
Legal Registered Office Address: 2951 MAPLE AVE
-
ZANESVILLE
United States of America (USA)
43701

More information about GENESIS HEALTHCARE SYSTEM

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0072022-01-01TERRY WILSON2023-10-13
0072021-01-01TERRY WILSON2022-10-13
0072020-01-01TERRY WILSON2021-10-13
0072019-01-01TERRY WILSON2020-10-14
0072018-01-01TERRY WILSON2019-10-15
0072017-01-01TERRY WILSON TERRY WILSON2018-10-15
0072017-01-01TERRY WILSON TERRY WILSON
0072017-01-01TERRY WILSON TERRY WILSON
0072016-01-01LISA CARPENTER LISA CARPENTER2017-10-16
0072015-01-01MARTHA NASH
0072014-01-01MARTHA NASH
0072013-01-01MARTHA NASH
0072012-01-01MARTHA NASH
0072011-01-01MARTHA NASH
0072009-01-01 JEFF ROBINSON2010-10-16
0072009-01-01JEFF ROBINSON
0072009-01-01JEFF ROBINSON

Plan Statistics for GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN

401k plan membership statisitcs for GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN

Measure Date Value
2022: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-014,005
Total number of active participants reported on line 7a of the Form 55002022-01-013,167
Number of retired or separated participants receiving benefits2022-01-0135
Number of other retired or separated participants entitled to future benefits2022-01-01984
Total of all active and inactive participants2022-01-014,186
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-014,186
Number of participants with account balances2022-01-014,186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-013,754
Total number of active participants reported on line 7a of the Form 55002021-01-013,091
Number of retired or separated participants receiving benefits2021-01-0137
Number of other retired or separated participants entitled to future benefits2021-01-01877
Total of all active and inactive participants2021-01-014,005
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-014,005
Number of participants with account balances2021-01-014,005
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-013,538
Total number of active participants reported on line 7a of the Form 55002020-01-012,939
Number of retired or separated participants receiving benefits2020-01-0138
Number of other retired or separated participants entitled to future benefits2020-01-01777
Total of all active and inactive participants2020-01-013,754
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-013,754
Number of participants with account balances2020-01-013,754
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-013,199
Total number of active participants reported on line 7a of the Form 55002019-01-012,807
Number of retired or separated participants receiving benefits2019-01-0139
Number of other retired or separated participants entitled to future benefits2019-01-01692
Total of all active and inactive participants2019-01-013,538
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-013,538
Number of participants with account balances2019-01-013,538
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-012,516
Total number of active participants reported on line 7a of the Form 55002018-01-012,516
Number of retired or separated participants receiving benefits2018-01-0133
Number of other retired or separated participants entitled to future benefits2018-01-01650
Total of all active and inactive participants2018-01-013,199
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-013,199
Number of participants with account balances2018-01-013,199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-012,974
Total number of active participants reported on line 7a of the Form 55002017-01-012,410
Number of retired or separated participants receiving benefits2017-01-0134
Number of other retired or separated participants entitled to future benefits2017-01-01635
Total of all active and inactive participants2017-01-013,079
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-013,079
Number of participants with account balances2017-01-013,079
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-012,850
Total number of active participants reported on line 7a of the Form 55002016-01-012,340
Number of retired or separated participants receiving benefits2016-01-0134
Number of other retired or separated participants entitled to future benefits2016-01-01600
Total of all active and inactive participants2016-01-012,974
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-012,974
Number of participants with account balances2016-01-012,974
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-012,687
Total number of active participants reported on line 7a of the Form 55002015-01-012,268
Number of retired or separated participants receiving benefits2015-01-0132
Number of other retired or separated participants entitled to future benefits2015-01-01550
Total of all active and inactive participants2015-01-012,850
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-012,850
Number of participants with account balances2015-01-012,850
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-012
2014: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-012,468
Total number of active participants reported on line 7a of the Form 55002014-01-012,170
Number of retired or separated participants receiving benefits2014-01-0127
Number of other retired or separated participants entitled to future benefits2014-01-01490
Total of all active and inactive participants2014-01-012,687
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-012,687
Number of participants with account balances2014-01-012,687
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-012,331
Total number of active participants reported on line 7a of the Form 55002013-01-012,060
Number of retired or separated participants receiving benefits2013-01-0124
Number of other retired or separated participants entitled to future benefits2013-01-01384
Total of all active and inactive participants2013-01-012,468
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-012,468
Number of participants with account balances2013-01-012,468
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-012,043
Total number of active participants reported on line 7a of the Form 55002012-01-012,002
Number of retired or separated participants receiving benefits2012-01-0122
Number of other retired or separated participants entitled to future benefits2012-01-01307
Total of all active and inactive participants2012-01-012,331
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-012,331
Number of participants with account balances2012-01-012,331
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,712
Total number of active participants reported on line 7a of the Form 55002011-01-011,760
Number of retired or separated participants receiving benefits2011-01-0121
Number of other retired or separated participants entitled to future benefits2011-01-01262
Total of all active and inactive participants2011-01-012,043
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-012,043
Number of participants with account balances2011-01-012,043
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,097
Total number of active participants reported on line 7a of the Form 55002009-01-011,487
Number of retired or separated participants receiving benefits2009-01-0143
Number of other retired or separated participants entitled to future benefits2009-01-01114
Total of all active and inactive participants2009-01-011,644
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-012
Total participants2009-01-011,646
Number of participants with account balances2009-01-011,646
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN

Measure Date Value
2022 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
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$0
Total income from all sources (including contributions)2022-12-31$-5,507,619
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$13,259,470
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$12,589,049
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$12,801,439
Value of total assets at end of year2022-12-31$153,874,907
Value of total assets at beginning of year2022-12-31$172,641,996
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$670,421
Total interest from all sources2022-12-31$2,844,019
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$2,000,000
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$10,007,639
Participant contributions at end of year2022-12-31$1,737,420
Participant contributions at beginning of year2022-12-31$1,530,655
Participant contributions at end of year2022-12-31$380,523
Participant contributions at beginning of year2022-12-31$368,564
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$483,374
Administrative expenses (other) incurred2022-12-31$670,421
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-18,767,089
Value of net assets at end of year (total assets less liabilities)2022-12-31$153,874,907
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$172,641,996
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$74,738,302
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$87,887,685
Value of interest in pooled separate accounts at end of year2022-12-31$11,125,246
Value of interest in pooled separate accounts at beginning of year2022-12-31$13,332,490
Interest on participant loans2022-12-31$72,999
Interest earned on other investments2022-12-31$2,771,020
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$65,804,915
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$69,439,946
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-21,153,077
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$2,310,426
Employer contributions (assets) at end of year2022-12-31$88,501
Employer contributions (assets) at beginning of year2022-12-31$82,656
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$12,589,049
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
Opinion of an independent qualified public accountant for this plan2022-12-31Disclaimer
Accountancy firm name2022-12-31REA & ASSOCIATES
Accountancy firm EIN2022-12-31341310124
2021 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-12-31$1,631,383
Total unrealized appreciation/depreciation of assets2021-12-31$1,631,383
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$29,805,988
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$9,925,425
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$9,258,489
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$13,200,349
Value of total assets at end of year2021-12-31$172,641,996
Value of total assets at beginning of year2021-12-31$152,761,433
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$666,936
Total interest from all sources2021-12-31$2,747,553
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$2,000,000
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$9,355,068
Participant contributions at end of year2021-12-31$1,530,655
Participant contributions at beginning of year2021-12-31$1,396,290
Participant contributions at end of year2021-12-31$368,564
Participant contributions at beginning of year2021-12-31$330,546
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$1,673,118
Administrative expenses (other) incurred2021-12-31$666,936
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$19,880,563
Value of net assets at end of year (total assets less liabilities)2021-12-31$172,641,996
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$152,761,433
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$87,887,685
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$75,030,378
Value of interest in pooled separate accounts at end of year2021-12-31$13,332,490
Value of interest in pooled separate accounts at beginning of year2021-12-31$11,838,178
Interest on participant loans2021-12-31$71,584
Interest earned on other investments2021-12-31$2,675,969
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$69,439,946
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$64,087,684
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$12,226,703
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$2,172,163
Employer contributions (assets) at end of year2021-12-31$82,656
Employer contributions (assets) at beginning of year2021-12-31$78,357
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$9,258,489
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
Opinion of an independent qualified public accountant for this plan2021-12-31Disclaimer
Accountancy firm name2021-12-31REA & ASSOCIATES
Accountancy firm EIN2021-12-31341310124
2020 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$1,642,538
Total unrealized appreciation/depreciation of assets2020-12-31$1,642,538
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$29,562,014
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$11,426,967
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$10,851,889
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$10,639,661
Value of total assets at end of year2020-12-31$152,761,433
Value of total assets at beginning of year2020-12-31$134,626,386
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$575,078
Total interest from all sources2020-12-31$2,463,002
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$2,000,000
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$8,031,337
Participant contributions at end of year2020-12-31$1,396,290
Participant contributions at beginning of year2020-12-31$1,497,794
Participant contributions at end of year2020-12-31$330,546
Participant contributions at beginning of year2020-12-31$286,738
Assets. Other investments not covered elsewhere at end of year2020-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$75,339
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$531,251
Administrative expenses (other) incurred2020-12-31$575,078
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$18,135,047
Value of net assets at end of year (total assets less liabilities)2020-12-31$152,761,433
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$134,626,386
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$75,030,378
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$63,718,828
Value of interest in pooled separate accounts at end of year2020-12-31$11,838,178
Value of interest in pooled separate accounts at beginning of year2020-12-31$11,206,224
Interest on participant loans2020-12-31$75,680
Interest earned on other investments2020-12-31$2,387,322
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$64,087,684
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$57,775,556
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$14,816,813
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 contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$2,077,073
Employer contributions (assets) at end of year2020-12-31$78,357
Employer contributions (assets) at beginning of year2020-12-31$65,907
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$10,851,889
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
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31REA & ASSOCIATES
Accountancy firm EIN2020-12-31341310124
2019 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$2,132,485
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$2,132,485
Total unrealized appreciation/depreciation of assets2019-12-31$2,132,485
Total unrealized appreciation/depreciation of assets2019-12-31$2,132,485
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total 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$28,214,161
Total income from all sources (including contributions)2019-12-31$28,214,161
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$10,654,968
Total of all expenses incurred2019-12-31$10,654,968
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$10,148,751
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$10,148,751
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$10,634,212
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$10,634,212
Value of total assets at end of year2019-12-31$134,626,386
Value of total assets at end of year2019-12-31$134,626,386
Value of total assets at beginning of year2019-12-31$117,067,193
Value of total assets at beginning of year2019-12-31$117,067,193
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$506,217
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$506,217
Total interest from all sources2019-12-31$2,320,701
Total interest from all sources2019-12-31$2,320,701
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$2,000,000
Value of fidelity bond cover2019-12-31$2,000,000
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
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$7,558,412
Contributions received from participants2019-12-31$7,558,412
Participant contributions at end of year2019-12-31$1,497,794
Participant contributions at end of year2019-12-31$1,497,794
Participant contributions at beginning of year2019-12-31$1,303,288
Participant contributions at beginning of year2019-12-31$1,303,288
Participant contributions at end of year2019-12-31$286,738
Participant contributions at end of year2019-12-31$286,738
Participant contributions at beginning of year2019-12-31$267,073
Participant contributions at beginning of year2019-12-31$267,073
Assets. Other investments not covered elsewhere at end of year2019-12-31$75,339
Assets. Other investments not covered elsewhere at end of year2019-12-31$75,339
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$94,468
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$94,468
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$1,280,154
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$1,280,154
Administrative expenses (other) incurred2019-12-31$506,217
Administrative expenses (other) incurred2019-12-31$506,217
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
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$17,559,193
Value of net income/loss2019-12-31$17,559,193
Value of net assets at end of year (total assets less liabilities)2019-12-31$134,626,386
Value of net assets at end of year (total assets less liabilities)2019-12-31$134,626,386
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$117,067,193
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$117,067,193
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 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
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$63,718,828
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$63,718,828
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$51,821,230
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$51,821,230
Value of interest in pooled separate accounts at end of year2019-12-31$11,206,224
Value of interest in pooled separate accounts at end of year2019-12-31$11,206,224
Value of interest in pooled separate accounts at beginning of year2019-12-31$10,126,543
Value of interest in pooled separate accounts at beginning of year2019-12-31$10,126,543
Interest on participant loans2019-12-31$72,059
Interest on participant loans2019-12-31$72,059
Interest earned on other investments2019-12-31$2,248,642
Interest earned on other investments2019-12-31$2,248,642
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$57,775,556
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$57,775,556
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$53,390,939
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$53,390,939
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$13,126,763
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$13,126,763
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
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 contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$1,795,646
Contributions received in cash from employer2019-12-31$1,795,646
Employer contributions (assets) at end of year2019-12-31$65,907
Employer contributions (assets) at end of year2019-12-31$65,907
Employer contributions (assets) at beginning of year2019-12-31$63,652
Employer contributions (assets) at beginning of year2019-12-31$63,652
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$10,148,751
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$10,148,751
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31REA & ASSOCIATES
Accountancy firm name2019-12-31REA & ASSOCIATES
Accountancy firm EIN2019-12-31341310124
Accountancy firm EIN2019-12-31341310124
2018 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-12-31$-732,381
Total unrealized appreciation/depreciation of assets2018-12-31$-732,381
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$5,008,410
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$9,253,137
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$9,201,751
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$8,990,958
Value of total assets at end of year2018-12-31$117,067,193
Value of total assets at beginning of year2018-12-31$121,311,920
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$51,386
Total interest from all sources2018-12-31$2,103,280
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
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$2,000,000
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$6,856,053
Participant contributions at end of year2018-12-31$1,303,288
Participant contributions at beginning of year2018-12-31$1,395,466
Participant contributions at end of year2018-12-31$267,073
Participant contributions at beginning of year2018-12-31$246,812
Assets. Other investments not covered elsewhere at end of year2018-12-31$94,468
Assets. Other investments not covered elsewhere at beginning of year2018-12-31$300,132
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$448,561
Administrative expenses (other) incurred2018-12-31$51,386
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-4,244,727
Value of net assets at end of year (total assets less liabilities)2018-12-31$117,067,193
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$121,311,920
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$51,821,230
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$54,720,206
Value of interest in pooled separate accounts at end of year2018-12-31$10,126,543
Value of interest in pooled separate accounts at beginning of year2018-12-31$12,219,708
Interest on participant loans2018-12-31$65,519
Interest earned on other investments2018-12-31$2,037,761
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$53,390,939
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$52,365,456
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-5,353,447
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 contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$1,686,344
Employer contributions (assets) at end of year2018-12-31$63,652
Employer contributions (assets) at beginning of year2018-12-31$64,140
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$9,201,751
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
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
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 name2018-12-31REA & ASSOCIATES
Accountancy firm EIN2018-12-31341310124
2017 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-12-31$511,223
Total unrealized appreciation/depreciation of assets2017-12-31$511,223
Total income from all sources (including contributions)2017-12-31$21,443,996
Total of all expenses incurred2017-12-31$8,007,069
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$7,960,552
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$8,363,157
Value of total assets at end of year2017-12-31$121,311,920
Value of total assets at beginning of year2017-12-31$107,874,993
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$46,517
Total interest from all sources2017-12-31$1,515,380
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$441,670
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$441,670
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$2,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$6,298,695
Participant contributions at end of year2017-12-31$1,395,466
Participant contributions at beginning of year2017-12-31$1,365,680
Participant contributions at end of year2017-12-31$246,812
Participant contributions at beginning of year2017-12-31$230,485
Assets. Other investments not covered elsewhere at end of year2017-12-31$300,132
Assets. Other investments not covered elsewhere at beginning of year2017-12-31$403,246
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$602,419
Administrative expenses (other) incurred2017-12-31$46,517
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$13,436,927
Value of net assets at end of year (total assets less liabilities)2017-12-31$121,311,920
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$107,874,993
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$55,214,452
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$47,540,658
Value of interest in pooled separate accounts at end of year2017-12-31$8,195,601
Value of interest in pooled separate accounts at beginning of year2017-12-31$7,476,627
Interest on participant loans2017-12-31$54,975
Interest earned on other investments2017-12-31$1,460,405
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$55,895,317
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$50,803,585
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$9,354,484
Net investment gain/loss from pooled separate accounts2017-12-31$1,258,082
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31Yes
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$1,462,043
Employer contributions (assets) at end of year2017-12-31$64,140
Employer contributions (assets) at beginning of year2017-12-31$54,712
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$7,960,552
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
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 name2017-12-31MCLAIN, HILL, RUGG & ASSOCIATES,INC
Accountancy firm EIN2017-12-31311038077
2016 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$199,888
Total unrealized appreciation/depreciation of assets2016-12-31$199,888
Total income from all sources (including contributions)2016-12-31$14,213,848
Total of all expenses incurred2016-12-31$6,756,869
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$6,716,157
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$8,035,726
Value of total assets at end of year2016-12-31$107,874,993
Value of total assets at beginning of year2016-12-31$100,418,014
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$40,712
Total interest from all sources2016-12-31$1,370,816
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$362,922
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$362,922
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$2,000,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$5,925,768
Participant contributions at end of year2016-12-31$1,365,680
Participant contributions at beginning of year2016-12-31$1,238,251
Participant contributions at end of year2016-12-31$230,485
Participant contributions at beginning of year2016-12-31$203,813
Assets. Other investments not covered elsewhere at end of year2016-12-31$403,246
Assets. Other investments not covered elsewhere at beginning of year2016-12-31$368,113
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$541,228
Administrative expenses (other) incurred2016-12-31$40,712
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$7,456,979
Value of net assets at end of year (total assets less liabilities)2016-12-31$107,874,993
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$100,418,014
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$47,540,658
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$43,687,316
Value of interest in pooled separate accounts at end of year2016-12-31$7,476,627
Value of interest in pooled separate accounts at beginning of year2016-12-31$7,608,371
Interest on participant loans2016-12-31$48,966
Interest earned on other investments2016-12-31$1,321,850
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$50,803,585
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$47,257,993
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$3,767,984
Net investment gain/loss from pooled separate accounts2016-12-31$476,512
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$1,568,730
Employer contributions (assets) at end of year2016-12-31$54,712
Employer contributions (assets) at beginning of year2016-12-31$54,157
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$6,716,157
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31MCLAIN, HILL, RUGG & ASSOCIATES,INC
Accountancy firm EIN2016-12-31311038077
2015 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$-22,985
Total unrealized appreciation/depreciation of assets2015-12-31$-22,985
Total income from all sources (including contributions)2015-12-31$10,854,599
Total of all expenses incurred2015-12-31$9,768,447
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$9,752,546
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$8,789,315
Value of total assets at end of year2015-12-31$100,418,014
Value of total assets at beginning of year2015-12-31$99,331,862
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$15,901
Total interest from all sources2015-12-31$1,305,837
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$381,936
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$381,936
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$2,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$5,823,676
Participant contributions at end of year2015-12-31$1,238,251
Participant contributions at beginning of year2015-12-31$1,283,969
Participant contributions at end of year2015-12-31$203,813
Participant contributions at beginning of year2015-12-31$372
Assets. Other investments not covered elsewhere at end of year2015-12-31$368,113
Assets. Other investments not covered elsewhere at beginning of year2015-12-31$366,868
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$1,383,261
Administrative expenses (other) incurred2015-12-31$15,901
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$1,086,152
Value of net assets at end of year (total assets less liabilities)2015-12-31$100,418,014
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$99,331,862
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$43,687,316
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$42,375,215
Value of interest in pooled separate accounts at end of year2015-12-31$7,608,371
Value of interest in pooled separate accounts at beginning of year2015-12-31$8,475,631
Interest on participant loans2015-12-31$45,219
Interest earned on other investments2015-12-31$1,260,618
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$47,257,993
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$46,829,701
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$493,166
Net investment gain/loss from pooled separate accounts2015-12-31$-92,670
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$1,582,378
Employer contributions (assets) at end of year2015-12-31$54,157
Employer contributions (assets) at beginning of year2015-12-31$106
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$9,752,546
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31MCLAIN, HILL, RUGG & ASSOCIATES,INC
Accountancy firm EIN2015-12-31311038077
2014 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$187,312
Total unrealized appreciation/depreciation of assets2014-12-31$187,312
Total income from all sources (including contributions)2014-12-31$12,102,457
Total of all expenses incurred2014-12-31$6,890,289
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$6,873,555
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$7,615,311
Value of total assets at end of year2014-12-31$99,331,862
Value of total assets at beginning of year2014-12-31$94,119,694
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$16,734
Total interest from all sources2014-12-31$1,251,560
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$335,737
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$335,737
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$2,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$5,239,402
Participant contributions at end of year2014-12-31$1,283,969
Participant contributions at beginning of year2014-12-31$1,186,526
Participant contributions at end of year2014-12-31$372
Participant contributions at beginning of year2014-12-31$744
Assets. Other investments not covered elsewhere at end of year2014-12-31$366,868
Assets. Other investments not covered elsewhere at beginning of year2014-12-31$325,319
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$891,203
Administrative expenses (other) incurred2014-12-31$16,734
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$5,212,168
Value of net assets at end of year (total assets less liabilities)2014-12-31$99,331,862
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$94,119,694
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$42,375,215
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$39,460,110
Value of interest in pooled separate accounts at end of year2014-12-31$8,475,631
Value of interest in pooled separate accounts at beginning of year2014-12-31$8,619,492
Interest on participant loans2014-12-31$42,669
Interest earned on other investments2014-12-31$1,208,891
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$46,829,701
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$44,527,289
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$2,149,977
Net investment gain/loss from pooled separate accounts2014-12-31$562,560
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$1,484,706
Employer contributions (assets) at end of year2014-12-31$106
Employer contributions (assets) at beginning of year2014-12-31$214
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$6,873,555
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31MCLAIN, HILL, RUGG & ASSOCIATES,INC
Accountancy firm EIN2014-12-31311038077
2013 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$433,715
Total unrealized appreciation/depreciation of assets2013-12-31$433,715
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$21,012,364
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$5,078,668
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$5,049,105
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$6,939,165
Value of total assets at end of year2013-12-31$96,707,733
Value of total assets at beginning of year2013-12-31$80,774,037
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$29,563
Total interest from all sources2013-12-31$1,161,465
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$250,634
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$250,634
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$2,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$4,888,567
Participant contributions at end of year2013-12-31$1,033,380
Participant contributions at beginning of year2013-12-31$866,615
Participant contributions at end of year2013-12-31$744
Participant contributions at beginning of year2013-12-31$376
Assets. Other investments not covered elsewhere at end of year2013-12-31$325,319
Assets. Other investments not covered elsewhere at beginning of year2013-12-31$289,486
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$562,019
Administrative expenses (other) incurred2013-12-31$29,563
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$15,933,696
Value of net assets at end of year (total assets less liabilities)2013-12-31$96,707,733
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$80,774,037
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$41,962,518
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$27,129,590
Value of interest in pooled separate accounts at end of year2013-12-31$8,463,406
Value of interest in pooled separate accounts at beginning of year2013-12-31$12,141,097
Interest on participant loans2013-12-31$38,638
Interest earned on other investments2013-12-31$1,122,827
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$44,922,152
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$40,346,776
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$9,548,187
Net investment gain/loss from pooled separate accounts2013-12-31$2,679,198
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$1,488,579
Employer contributions (assets) at end of year2013-12-31$214
Employer contributions (assets) at beginning of year2013-12-31$97
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$5,049,105
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31MCLAIN, HILL, RUGG & ASSOCIATES,INC
Accountancy firm EIN2013-12-31311038077
2012 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$524,191
Total unrealized appreciation/depreciation of assets2012-12-31$524,191
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$3,590
Total income from all sources (including contributions)2012-12-31$12,750,018
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$4,729,549
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$4,713,362
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$6,800,575
Value of total assets at end of year2012-12-31$80,774,037
Value of total assets at beginning of year2012-12-31$72,757,158
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$16,187
Total interest from all sources2012-12-31$1,049,289
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$234,991
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$234,991
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$2,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$4,456,796
Participant contributions at end of year2012-12-31$866,615
Participant contributions at beginning of year2012-12-31$716,805
Participant contributions at end of year2012-12-31$376
Participant contributions at beginning of year2012-12-31$561
Assets. Other investments not covered elsewhere at end of year2012-12-31$289,486
Assets. Other investments not covered elsewhere at beginning of year2012-12-31$240,131
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$964,548
Administrative expenses (other) incurred2012-12-31$16,187
Liabilities. Value of operating payables at end of year2012-12-31$0
Liabilities. Value of operating payables at beginning of year2012-12-31$3,590
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$8,020,469
Value of net assets at end of year (total assets less liabilities)2012-12-31$80,774,037
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$72,753,568
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$27,129,590
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$22,809,158
Value of interest in pooled separate accounts at end of year2012-12-31$12,141,097
Value of interest in pooled separate accounts at beginning of year2012-12-31$12,388,220
Interest on participant loans2012-12-31$37,465
Interest earned on other investments2012-12-31$1,011,824
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$40,346,776
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$36,602,101
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$2,645,235
Net investment gain/loss from pooled separate accounts2012-12-31$1,495,737
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$1,379,231
Employer contributions (assets) at end of year2012-12-31$97
Employer contributions (assets) at beginning of year2012-12-31$182
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$4,713,362
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31MCLAIN, HILL, RUGG & ASSOCIATES,INC
Accountancy firm EIN2012-12-31311038077
2011 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$-84,410
Total unrealized appreciation/depreciation of assets2011-12-31$-84,410
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$3,590
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$7,006,601
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$3,125,625
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$3,105,841
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$7,205,258
Value of total assets at end of year2011-12-31$72,757,158
Value of total assets at beginning of year2011-12-31$68,872,592
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$19,784
Total interest from all sources2011-12-31$944,563
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$190,866
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$190,866
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$2,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$3,932,191
Participant contributions at end of year2011-12-31$716,805
Participant contributions at beginning of year2011-12-31$655,774
Participant contributions at end of year2011-12-31$561
Assets. Other investments not covered elsewhere at end of year2011-12-31$240,131
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$248,004
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$1,982,594
Administrative expenses (other) incurred2011-12-31$19,784
Liabilities. Value of operating payables at end of year2011-12-31$3,590
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$3,880,976
Value of net assets at end of year (total assets less liabilities)2011-12-31$72,753,568
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$68,872,592
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$22,809,158
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$21,021,703
Value of interest in pooled separate accounts at end of year2011-12-31$12,388,220
Value of interest in pooled separate accounts at beginning of year2011-12-31$13,219,999
Interest on participant loans2011-12-31$28,268
Interest earned on other investments2011-12-31$916,295
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$36,602,101
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$33,727,112
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-624,508
Net investment gain/loss from pooled separate accounts2011-12-31$-625,168
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31Yes
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$1,290,473
Employer contributions (assets) at end of year2011-12-31$182
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$3,105,841
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31MCLAIN, HILL, RUGG & ASSOCIATES,INC
Accountancy firm EIN2011-12-31311038077
2010 : GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$11,954,302
Total loss/gain on sale of assets2010-12-31$104,456
Total of all expenses incurred2010-12-31$5,171,424
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$5,157,372
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$6,674,746
Value of total assets at end of year2010-12-31$68,872,592
Value of total assets at beginning of year2010-12-31$62,089,714
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$14,052
Total interest from all sources2010-12-31$887,905
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$146,934
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$146,934
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$2,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$3,813,703
Participant contributions at end of year2010-12-31$655,774
Participant contributions at beginning of year2010-12-31$433,010
Participant contributions at beginning of year2010-12-31$144,663
Assets. Other investments not covered elsewhere at end of year2010-12-31$248,004
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$197,489
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$1,594,670
Other income not declared elsewhere2010-12-31$42,893
Administrative expenses (other) incurred2010-12-31$14,052
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$6,782,878
Value of net assets at end of year (total assets less liabilities)2010-12-31$68,872,592
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$62,089,714
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$21,021,703
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$17,201,601
Value of interest in pooled separate accounts at end of year2010-12-31$13,219,999
Value of interest in pooled separate accounts at beginning of year2010-12-31$13,112,406
Interest on participant loans2010-12-31$25,541
Interest earned on other investments2010-12-31$862,364
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$33,727,112
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$30,951,962
Net investment gain/loss from pooled separate accounts2010-12-31$4,097,368
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$1,266,373
Employer contributions (assets) at beginning of year2010-12-31$48,583
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$5,157,372
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Aggregate proceeds on sale of assets2010-12-31$104,456
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31MCLAIN HILL RUGG & ASSOCIATES, INC.
Accountancy firm EIN2010-12-31311038077

Form 5500 Responses for GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN

2022: GENESIS HEALTHCARE SYSTEM TDA THRIFT 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: GENESIS HEALTHCARE SYSTEM TDA THRIFT 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: GENESIS HEALTHCARE SYSTEM TDA THRIFT 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: GENESIS HEALTHCARE SYSTEM TDA THRIFT 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: GENESIS HEALTHCARE SYSTEM TDA THRIFT 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: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: GENESIS HEALTHCARE SYSTEM TDA THRIFT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117
Policy instance 6
Insurance contract or identification number16033117
Number of Individuals Covered32
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $17,401
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $13,386
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB01413
Policy instance 5
Insurance contract or identification numberB01413
Number of Individuals Covered3
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 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?Yes
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
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number005389
Policy instance 4
Insurance contract or identification number005389
Number of Individuals Covered4186
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 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?Yes
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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 3
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered17
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 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?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number919734
Policy instance 2
Insurance contract or identification number919734
Number of Individuals Covered119
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 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?Yes
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
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 1
Insurance contract or identification numberG05580
Number of Individuals Covered99
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 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?Yes
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
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 1
Insurance contract or identification numberG05580
Number of Individuals Covered103
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 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?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number919734
Policy instance 2
Insurance contract or identification number919734
Number of Individuals Covered123
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 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?Yes
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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 3
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered19
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 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?Yes
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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number005389
Policy instance 4
Insurance contract or identification number005389
Number of Individuals Covered4005
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 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?Yes
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
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB01413
Policy instance 5
Insurance contract or identification numberB01413
Number of Individuals Covered3
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 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?Yes
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
RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117
Policy instance 6
Insurance contract or identification number16033117
Number of Individuals Covered33
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $19,149
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $14,362
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 1
Insurance contract or identification numberG05580
Number of Individuals Covered108
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 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?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number919734
Policy instance 2
Insurance contract or identification number919734
Number of Individuals Covered134
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 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?Yes
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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 3
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered19
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 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?Yes
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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number005389
Policy instance 4
Insurance contract or identification number005389
Number of Individuals Covered3754
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 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?Yes
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
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB01413
Policy instance 5
Insurance contract or identification numberB01413
Number of Individuals Covered3
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 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?Yes
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
RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117
Policy instance 6
Insurance contract or identification number16033117
Number of Individuals Covered36
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $17,583
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $12,621
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB01413
Policy instance 6
Insurance contract or identification numberB01413
Number of Individuals Covered3
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 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?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number1014314-01
Policy instance 5
Insurance contract or identification number1014314-01
Number of Individuals Covered0
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 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?Yes
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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number005389
Policy instance 4
Insurance contract or identification number005389
Number of Individuals Covered3538
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 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?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number919734
Policy instance 2
Insurance contract or identification number919734
Number of Individuals Covered144
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 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?Yes
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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 3
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered20
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 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?Yes
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
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 1
Insurance contract or identification numberG05580
Number of Individuals Covered117
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 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?Yes
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
RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117
Policy instance 7
Insurance contract or identification number16033117
Number of Individuals Covered40
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $21,592
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $12,379
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 1
Insurance contract or identification numberG05580
Number of Individuals Covered124
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 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?Yes
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
RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117
Policy instance 7
Insurance contract or identification number16033117
Number of Individuals Covered42
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $25,347
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?1
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $12,643
Insurance broker organization code?3
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB01413
Policy instance 6
Insurance contract or identification numberB01413
Number of Individuals Covered4
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 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?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number1014314-01
Policy instance 5
Insurance contract or identification number1014314-01
Number of Individuals Covered5
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 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?Yes
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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number005389
Policy instance 4
Insurance contract or identification number005389
Number of Individuals Covered3199
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 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?Yes
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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 3
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered30
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 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?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number919734
Policy instance 2
Insurance contract or identification number919734
Number of Individuals Covered153
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $97
Total amount of fees paid to insurance companyUSD $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 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?Yes
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 $97
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerASSET ALLOCATION ADVICE REBALANCING SERVICES
Insurance broker organization code?3
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number919734
Policy instance 2
Insurance contract or identification number919734
Number of Individuals Covered161
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $7,026
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 BrokerUSD $7,026
Additional information about fees paid to insurance brokerASSET ALLOCATION ADVICE REBALANCING SERVICES
Insurance broker organization code?3
Insurance broker nameBRIGHTHOUSE SECURITIES, LLC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 3
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered34
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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
RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117
Policy instance 4
Insurance contract or identification number16033117
Number of Individuals Covered44
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $24,823
Are there contracts with allocated funds for individual policies?1
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 BrokerUSD $12,222
Insurance broker organization code?3
Insurance broker nameANDREW BRATE
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number005389
Policy instance 5
Insurance contract or identification number005389
Number of Individuals Covered3079
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker nameUBS FINANCIAL SRVCS INS AGENCY INC
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number1014314-01
Policy instance 6
Insurance contract or identification number1014314-01
Number of Individuals Covered4
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number080168
Policy instance 7
Insurance contract or identification number080168
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB01413
Policy instance 8
Insurance contract or identification numberB01413
Number of Individuals Covered4
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 1
Insurance contract or identification numberG05580
Number of Individuals Covered131
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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
METLIFE INVESTORS (National Association of Insurance Commissioners NAIC id number: 80950 )
Policy contract number919734
Policy instance 2
Insurance contract or identification number919734
Number of Individuals Covered187
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $20,503
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
Amount paid for insurance broker fees20503
Additional information about fees paid to insurance brokerASSET ALLOCATION ADVICE AND REBALANCING SERVICES FOR PLAN PARTI
Insurance broker organization code?3
Insurance broker nameMETLIFE SECURITIES, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 1
Insurance contract or identification numberG05580
Number of Individuals Covered149
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 3
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered47
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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
RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117
Policy instance 4
Insurance contract or identification number16033117
Number of Individuals Covered54
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $26,106
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,430
Insurance broker organization code?3
Insurance broker nameANDY OGILIVIE
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number005389
Policy instance 5
Insurance contract or identification number005389
Number of Individuals Covered2850
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $81,671
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
Amount paid for insurance broker fees81671
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker nameUBS FINANCIAL SRVCS INS AGENCY INC
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number1014314-01
Policy instance 6
Insurance contract or identification number1014314-01
Number of Individuals Covered3
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number080168
Policy instance 7
Insurance contract or identification number080168
Number of Individuals Covered2
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number005389
Policy instance 8
Insurance contract or identification number005389
Number of Individuals Covered2850
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $1,134
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1134
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker organization code?3
Insurance broker nameUBS FINANCIAL SRVCS INS AGENCY INC
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberB01413
Policy instance 9
Insurance contract or identification numberB01413
Number of Individuals Covered7
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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
RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117
Policy instance 4
Insurance contract or identification number16033117
Number of Individuals Covered56
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $25,154
Are there contracts with allocated funds for individual policies?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,556
Insurance broker organization code?3
Insurance broker nameANDY OGILIVIE
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number919734
Policy instance 2
Insurance contract or identification number919734
Number of Individuals Covered74
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of fees paid to insurance companyUSD $21,277
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
Amount paid for insurance broker fees21277
Additional information about fees paid to insurance brokerASSET ALLOCATION ADVICE AND REBALANCING SERVICES FOR PLAN PARTI
Insurance broker organization code?3
Insurance broker nameMETLIFE SECURITIES, INC.
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 3
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered50
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number005389
Policy instance 5
Insurance contract or identification number005389
Number of Individuals Covered2687
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of fees paid to insurance companyUSD $78,258
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
Amount paid for insurance broker fees78258
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker nameUBS FINANCIAL SRVCS INS AGENCY INC
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number1014314-01
Policy instance 6
Insurance contract or identification number1014314-01
Number of Individuals Covered3
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number080168,080118
Policy instance 7
Insurance contract or identification number080168,080118
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 1
Insurance contract or identification numberG05580
Number of Individuals Covered163
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number919734
Policy instance 2
Insurance contract or identification number919734
Number of Individuals Covered79
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $21,033
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 fees21033
Additional information about fees paid to insurance brokerASSET ALLOCATION ADVICE AND REBALANCING SERVICES FOR PLAN PARTI
Insurance broker organization code?3
Insurance broker nameMETLIFE SECURITIES, INC.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1014314-01
Policy instance 6
Insurance contract or identification number1014314-01
Number of Individuals Covered3
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117
Policy instance 4
Insurance contract or identification number16033117
Number of Individuals Covered59
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $23,545
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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?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 $12,781
Insurance broker organization code?3
Insurance broker nameDEBORAH LINSCOTT-WINDAU
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number005389
Policy instance 5
Insurance contract or identification number005389
Number of Individuals Covered2468
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $71,849
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 fees71849
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker nameUBS FINANCIAL SRVCS INS AGENCY INC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 1
Insurance contract or identification numberG05580
Number of Individuals Covered173
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 3
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered51
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1014314-01
Policy instance 1
Insurance contract or identification number1014314-01
Number of Individuals Covered3
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 6
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered56
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117-9
Policy instance 4
Insurance contract or identification number16033117-9
Number of Individuals Covered155
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,043
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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?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 $7,212
Insurance broker organization code?3
Insurance broker nameDAVID WHITESMITH
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 3
Insurance contract or identification numberG05580
Number of Individuals Covered182
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number005389
Policy instance 2
Insurance contract or identification number005389
Number of Individuals Covered2331
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $64,066
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 fees64066
Additional information about fees paid to insurance brokerSERVICES TO INSURERE OR PLAN
Insurance broker organization code?0
Insurance broker nameUBS FINANCIAL SRVCS INS AGENCY INC
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number919734
Policy instance 5
Insurance contract or identification number919734
Number of Individuals Covered84
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $20,496
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 fees20496
Additional information about fees paid to insurance brokerASSET ALLOCATION ADVICE AND REBALANCING SERVICES FOR PLAN PARTICIPANTS WHO ELECTED TO RECEIVE THEM
Insurance broker organization code?3
Insurance broker nameMETLIFE SECURITIES, INC.
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 6
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered60
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number919734
Policy instance 5
Insurance contract or identification number919734
Number of Individuals Covered237
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $22,205
Total amount of fees paid to insurance companyUSD $0
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number005389
Policy instance 4
Insurance contract or identification number005389
Number of Individuals Covered2043
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $57,928
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117-9
Policy instance 3
Insurance contract or identification number16033117-9
Number of Individuals Covered155
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,981
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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?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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1014314-01
Policy instance 2
Insurance contract or identification number1014314-01
Number of Individuals Covered3
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 1
Insurance contract or identification numberG05580
Number of Individuals Covered195
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number1014314-01
Policy instance 3
Insurance contract or identification number1014314-01
Number of Individuals Covered3
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number919734
Policy instance 1
Insurance contract or identification number919734
Number of Individuals Covered253
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $25,119
Total amount of fees paid to insurance companyUSD $0
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number005389
Policy instance 4
Insurance contract or identification number005389
Number of Individuals Covered1712
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $52,251
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG05580
Policy instance 5
Insurance contract or identification numberG05580
Number of Individuals Covered207
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
RIVERSOURCE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65005 )
Policy contract number16033117-9
Policy instance 6
Insurance contract or identification number16033117-9
Number of Individuals Covered155
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $7,953
Total amount of fees paid to insurance companyUSD $0
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?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
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberCOPE0101CC37
Policy instance 2
Insurance contract or identification numberCOPE0101CC37
Number of Individuals Covered69
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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

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