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FIVOS, INC. 401(K) PLAN 401k Plan overview

Plan NameFIVOS, INC. 401(K) PLAN
Plan identification number 001

FIVOS, INC. 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan covering Self-Employed individuals.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

FIVOS INC. has sponsored the creation of one or more 401k plans.

Company Name:FIVOS INC.
Employer identification number (EIN):451573625
NAIC Classification:621510
NAIC Description: Medical and Diagnostic Laboratories

Additional information about FIVOS INC.

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division
Incorporation Date: 2007-01-04
Company Identification Number: 602682609
Legal Registered Office Address: 500 UNION ST STE 800

SEATTLE
United States of America (USA)
98101

More information about FIVOS INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIVOS, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01
0012022-01-01
0012021-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01KATIE EMERSON KATIE EMERSON2018-10-15

Plan Statistics for FIVOS, INC. 401(K) PLAN

401k plan membership statisitcs for FIVOS, INC. 401(K) PLAN

Measure Date Value
2023: FIVOS, INC. 401(K) PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01126
Total number of active participants reported on line 7a of the Form 55002023-01-0158
Number of retired or separated participants receiving benefits2023-01-011
Number of other retired or separated participants entitled to future benefits2023-01-0145
Total of all active and inactive participants2023-01-01104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2023-01-010
Total participants2023-01-01104
Number of participants with account balances2023-01-0195
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2023-01-0117
2022: FIVOS, INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01126
Total number of active participants reported on line 7a of the Form 55002022-01-0185
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0141
Total of all active and inactive participants2022-01-01126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01126
Number of participants with account balances2022-01-01101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-017
2021: FIVOS, INC. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01130
Total number of active participants reported on line 7a of the Form 55002021-01-0184
Number of retired or separated participants receiving benefits2021-01-016
Number of other retired or separated participants entitled to future benefits2021-01-0136
Total of all active and inactive participants2021-01-01126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01126
Number of participants with account balances2021-01-01105
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-015
2020: FIVOS, INC. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01161
Total number of active participants reported on line 7a of the Form 55002020-01-0196
Number of retired or separated participants receiving benefits2020-01-013
Number of other retired or separated participants entitled to future benefits2020-01-0131
Total of all active and inactive participants2020-01-01130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01130
Number of participants with account balances2020-01-0199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-019
2019: FIVOS, INC. 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01150
Total number of active participants reported on line 7a of the Form 55002019-01-01123
Number of retired or separated participants receiving benefits2019-01-019
Number of other retired or separated participants entitled to future benefits2019-01-0130
Total of all active and inactive participants2019-01-01162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01162
Number of participants with account balances2019-01-01109
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-013
2018: FIVOS, INC. 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01144
Total number of active participants reported on line 7a of the Form 55002018-01-01119
Number of retired or separated participants receiving benefits2018-01-017
Number of other retired or separated participants entitled to future benefits2018-01-0123
Total of all active and inactive participants2018-01-01149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01149
Number of participants with account balances2018-01-0197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-012
2017: FIVOS, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01143
Total number of active participants reported on line 7a of the Form 55002017-01-01124
Number of retired or separated participants receiving benefits2017-01-012
Number of other retired or separated participants entitled to future benefits2017-01-0119
Total of all active and inactive participants2017-01-01145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01145
Number of participants with account balances2017-01-0184
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010

Financial Data on FIVOS, INC. 401(K) PLAN

Measure Date Value
2023 : FIVOS, INC. 401(K) PLAN 2023 401k financial data
Unrealized appreciation/depreciation of real estate assets2023-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2023-12-31$0
Total unrealized appreciation/depreciation of assets2023-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Expenses. Interest paid2023-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022023-12-31$0
Total income from all sources (including contributions)2023-12-31$3,082,858
Total loss/gain on sale of assets2023-12-31$0
Total of all expenses incurred2023-12-31$1,846,981
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$1,806,702
Expenses. Certain deemed distributions of participant loans2023-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$1,753,053
Value of total assets at end of year2023-12-31$9,307,608
Value of total assets at beginning of year2023-12-31$8,071,731
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$40,279
Total income from rents2023-12-31$0
Total interest from all sources2023-12-31$11,487
Total dividends received (eg from common stock, registered investment company shares)2023-12-31$253,978
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2023-12-31$253,978
Assets. Real estate other than employer real property at end of year2023-12-31$0
Assets. Real estate other than employer real property at beginning of year2023-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2023-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2023-12-31$0
Was this plan covered by a fidelity bond2023-12-31Yes
Value of fidelity bond cover2023-12-31$500,000
If this is an individual account plan, was there a blackout period2023-12-31No
Were there any nonexempt tranactions with any party-in-interest2023-12-31No
Contributions received from participants2023-12-31$768,295
Participant contributions at end of year2023-12-31$173,200
Participant contributions at beginning of year2023-12-31$140,300
Participant contributions at end of year2023-12-31$0
Participant contributions at beginning of year2023-12-31$0
Assets. Other investments not covered elsewhere at end of year2023-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2023-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2023-12-31$650,476
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2023-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-12-31$0
Assets. Loans (other than to participants) at end of year2023-12-31$0
Assets. Loans (other than to participants) at beginning of year2023-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-12-31$0
Administrative expenses (other) incurred2023-12-31$0
Total non interest bearing cash at end of year2023-12-31$0
Total non interest bearing cash at beginning of year2023-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Income. Non cash contributions2023-12-31$0
Value of net income/loss2023-12-31$1,235,877
Value of net assets at end of year (total assets less liabilities)2023-12-31$9,307,608
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$8,071,731
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-12-31No
Were any leases to which the plan was party in default or uncollectible2023-12-31No
Assets. partnership/joint venture interests at end of year2023-12-31$0
Assets. partnership/joint venture interests at beginning of year2023-12-31$0
Investment advisory and management fees2023-12-31$29,561
Value of interest in registered invesment companies (eg mutual funds) at end of year2023-12-31$8,720,600
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-12-31$7,261,584
Value of interest in pooled separate accounts at end of year2023-12-31$0
Value of interest in pooled separate accounts at beginning of year2023-12-31$660,125
Interest on participant loans2023-12-31$9,157
Income. Interest from loans (other than to participants)2023-12-31$0
Interest earned on other investments2023-12-31$2,330
Income. Interest from US Government securities2023-12-31$0
Income. Interest from corporate debt instruments2023-12-31$0
Value of interest in master investment trust accounts at end of year2023-12-31$0
Value of interest in master investment trust accounts at beginning of year2023-12-31$0
Value of interest in common/collective trusts at end of year2023-12-31$0
Value of interest in common/collective trusts at beginning of year2023-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2023-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2023-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2023-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2023-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2023-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2023-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2023-12-31$413,808
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2023-12-31$9,722
Expenses. Payments to insurance carriers foe the provision of benefits2023-12-31$0
Asset value of US Government securities at end of year2023-12-31$0
Asset value of US Government securities at beginning of year2023-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2023-12-31$1,064,340
Net investment gain/loss from pooled separate accounts2023-12-31$0
Net investment gain or loss from common/collective trusts2023-12-31$0
Net gain/loss from 103.12 investment entities2023-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-12-31No
Was there a failure to transmit to the plan any participant contributions2023-12-31Yes
Has the plan failed to provide any benefit when due under the plan2023-12-31No
Assets. Invements in employer securities at end of year2023-12-31$0
Assets. Invements in employer securities at beginning of year2023-12-31$0
Assets. Value of employer real property at end of year2023-12-31$0
Assets. Value of employer real property at beginning of year2023-12-31$0
Contributions received in cash from employer2023-12-31$334,282
Employer contributions (assets) at end of year2023-12-31$0
Employer contributions (assets) at beginning of year2023-12-31$0
Income. Dividends from preferred stock2023-12-31$0
Income. Dividends from common stock2023-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-12-31$1,806,702
Asset. Corporate debt instrument preferred debt at end of year2023-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2023-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2023-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2023-12-31$0
Contract administrator fees2023-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2023-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2023-12-31$0
Liabilities. Value of benefit claims payable at end of year2023-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2023-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2023-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2023-12-31$0
Did the plan have assets held for investment2023-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-12-31No
Aggregate proceeds on sale of assets2023-12-31$0
Aggregate carrying amount (costs) on sale of assets2023-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2023-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2023-12-31$0
Opinion of an independent qualified public accountant for this plan2023-12-31Unqualified
Accountancy firm name2023-12-31GALLAGHER, FLYNNE AND COMPANY, LLP
Accountancy firm EIN2023-12-31030225774
2022 : FIVOS, INC. 401(K) PLAN 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets2022-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$0
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
Expenses. Interest paid2022-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022022-12-31$0
Total income from all sources (including contributions)2022-12-31$-580,491
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$1,780,951
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,771,947
Expenses. Certain deemed distributions of participant loans2022-12-31$5,762
Value of total corrective distributions2022-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,099,268
Value of total assets at end of year2022-12-31$8,071,731
Value of total assets at beginning of year2022-12-31$10,433,173
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$3,242
Total income from rents2022-12-31$0
Total interest from all sources2022-12-31$8,854
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$163,462
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$163,462
Assets. Real estate other than employer real property at end of year2022-12-31$0
Assets. Real estate other than employer real property at beginning of year2022-12-31$0
Administrative expenses professional fees incurred2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$730,123
Participant contributions at end of year2022-12-31$140,300
Participant contributions at beginning of year2022-12-31$165,027
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Assets. Other investments not covered elsewhere at end of year2022-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$69,198
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Assets. Loans (other than to participants) at end of year2022-12-31$0
Assets. Loans (other than to participants) at beginning of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Other income not declared elsewhere2022-12-31$3,838
Administrative expenses (other) incurred2022-12-31$0
Total non interest bearing cash at end of year2022-12-31$0
Total non interest bearing cash at beginning of year2022-12-31$19,513
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
Income. Non cash contributions2022-12-31$0
Value of net income/loss2022-12-31$-2,361,442
Value of net assets at end of year (total assets less liabilities)2022-12-31$8,071,731
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$10,433,173
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
Assets. partnership/joint venture interests at end of year2022-12-31$0
Assets. partnership/joint venture interests at beginning of year2022-12-31$0
Investment advisory and management fees2022-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$7,261,584
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$0
Value of interest in pooled separate accounts at end of year2022-12-31$660,125
Value of interest in pooled separate accounts at beginning of year2022-12-31$10,248,633
Interest on participant loans2022-12-31$8,849
Income. Interest from loans (other than to participants)2022-12-31$0
Interest earned on other investments2022-12-31$5
Income. Interest from US Government securities2022-12-31$0
Income. Interest from corporate debt instruments2022-12-31$0
Value of interest in master investment trust accounts at end of year2022-12-31$0
Value of interest in master investment trust accounts at beginning of year2022-12-31$0
Value of interest in common/collective trusts at end of year2022-12-31$0
Value of interest in common/collective trusts at beginning of year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2022-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$9,722
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$0
Asset value of US Government securities at end of year2022-12-31$0
Asset value of US Government securities at beginning of year2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-301,861
Net investment gain/loss from pooled separate accounts2022-12-31$-1,554,052
Net investment gain or loss from common/collective trusts2022-12-31$0
Net gain/loss from 103.12 investment entities2022-12-31$0
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
Assets. Invements in employer securities at end of year2022-12-31$0
Assets. Invements in employer securities at beginning of year2022-12-31$0
Assets. Value of employer real property at end of year2022-12-31$0
Assets. Value of employer real property at beginning of year2022-12-31$0
Contributions received in cash from employer2022-12-31$299,947
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$0
Income. Dividends from preferred stock2022-12-31$0
Income. Dividends from common stock2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,771,947
Asset. Corporate debt instrument preferred debt at end of year2022-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2022-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2022-12-31$0
Contract administrator fees2022-12-31$3,242
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31Yes
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$0
Liabilities. Value of benefit claims payable at end of year2022-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2022-12-31$0
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$0
Aggregate carrying amount (costs) on sale of assets2022-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2022-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2022-12-31$0
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31GALLAGHER, FLYNNE AND COMPANY, LLP
Accountancy firm EIN2022-12-31030225774
2021 : FIVOS, INC. 401(K) PLAN 2021 401k financial data
Expenses. Interest paid2021-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022021-12-31$0
Total income from all sources (including contributions)2021-12-31$2,510,808
Total of all expenses incurred2021-12-31$1,405,059
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,394,880
Expenses. Certain deemed distributions of participant loans2021-12-31$7,471
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,315,178
Value of total assets at end of year2021-12-31$10,413,660
Value of total assets at beginning of year2021-12-31$9,307,911
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$2,708
Total interest from all sources2021-12-31$12,553
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$699,928
Participant contributions at end of year2021-12-31$165,027
Participant contributions at beginning of year2021-12-31$214,951
Participant contributions at beginning of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$324,969
Other income not declared elsewhere2021-12-31$2,927
Administrative expenses (other) incurred2021-12-31$2,400
Total non interest bearing cash at end of year2021-12-31$0
Total non interest bearing cash at beginning of year2021-12-31$12,781
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
Income. Non cash contributions2021-12-31$0
Value of net income/loss2021-12-31$1,105,749
Value of net assets at end of year (total assets less liabilities)2021-12-31$10,413,660
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$9,307,911
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 pooled separate accounts at end of year2021-12-31$10,248,633
Value of interest in pooled separate accounts at beginning of year2021-12-31$9,080,179
Interest on participant loans2021-12-31$12,553
Income. Interest from loans (other than to participants)2021-12-31$0
Net investment gain/loss from pooled separate accounts2021-12-31$1,180,150
Net investment gain or loss from common/collective trusts2021-12-31$0
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$290,281
Employer contributions (assets) at beginning of year2021-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,394,880
Contract administrator fees2021-12-31$308
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 plan2021-12-31Unqualified
Accountancy firm name2021-12-31GALLAGHER, FLYNN AND COMPANY, LLP
Accountancy firm EIN2021-12-31030225774
2020 : FIVOS, INC. 401(K) PLAN 2020 401k financial data
Total income from all sources (including contributions)2020-12-31$2,398,043
Total of all expenses incurred2020-12-31$1,292,128
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$1,287,011
Value of total corrective distributions2020-12-31$1,151
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,198,642
Value of total assets at end of year2020-12-31$9,307,911
Value of total assets at beginning of year2020-12-31$8,201,996
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$3,966
Total interest from all sources2020-12-31$13,799
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$3,600
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$617,351
Participant contributions at end of year2020-12-31$214,951
Participant contributions at beginning of year2020-12-31$202,946
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$328,383
Other income not declared elsewhere2020-12-31$123
Total non interest bearing cash at end of year2020-12-31$12,781
Total non interest bearing cash at beginning of year2020-12-31$0
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
Income. Non cash contributions2020-12-31$0
Value of net income/loss2020-12-31$1,105,915
Value of net assets at end of year (total assets less liabilities)2020-12-31$9,307,911
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$8,201,996
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 pooled separate accounts at end of year2020-12-31$9,080,179
Value of interest in pooled separate accounts at beginning of year2020-12-31$7,999,050
Interest on participant loans2020-12-31$13,799
Net investment gain/loss from pooled separate accounts2020-12-31$1,185,479
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$252,908
Employer contributions (assets) at end of year2020-12-31$0
Employer contributions (assets) at beginning of year2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$1,287,011
Contract administrator fees2020-12-31$366
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 name2020-12-31CARON & BLETZER, PLLC
Accountancy firm EIN2020-12-31043499945
2019 : FIVOS, INC. 401(K) PLAN 2019 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$155
Expenses. Interest paid2019-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022019-12-31$0
Total income from all sources (including contributions)2019-12-31$2,337,245
Total of all expenses incurred2019-12-31$264,073
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$252,188
Expenses. Certain deemed distributions of participant loans2019-12-31$0
Value of total corrective distributions2019-12-31$2,218
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,033,723
Value of total assets at end of year2019-12-31$8,201,996
Value of total assets at beginning of year2019-12-31$6,128,979
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$9,667
Total interest from all sources2019-12-31$12,134
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$250,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$621,971
Participant contributions at end of year2019-12-31$202,946
Participant contributions at beginning of year2019-12-31$191,666
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$574
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$145,827
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$155
Administrative expenses (other) incurred2019-12-31$6,155
Total non interest bearing cash at end of year2019-12-31$0
Total non interest bearing cash at beginning of year2019-12-31$368
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$2,073,172
Value of net assets at end of year (total assets less liabilities)2019-12-31$8,201,996
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$6,128,824
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$312
Value of interest in pooled separate accounts at end of year2019-12-31$7,999,050
Value of interest in pooled separate accounts at beginning of year2019-12-31$5,936,371
Interest on participant loans2019-12-31$12,134
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Net investment gain/loss from pooled separate accounts2019-12-31$1,291,388
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$265,925
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$252,188
Contract administrator fees2019-12-31$3,200
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
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31CARON & BLETZER, PLLC
Accountancy firm EIN2019-12-31043499945
2018 : FIVOS, INC. 401(K) PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$155
Total income from all sources (including contributions)2018-12-31$490,041
Total of all expenses incurred2018-12-31$213,103
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$210,901
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$918,247
Value of total assets at end of year2018-12-31$6,128,979
Value of total assets at beginning of year2018-12-31$5,851,886
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$2,202
Total interest from all sources2018-12-31$7,483
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$250,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$580,681
Participant contributions at end of year2018-12-31$191,666
Participant contributions at beginning of year2018-12-31$82,875
Participant contributions at end of year2018-12-31$574
Participant contributions at beginning of year2018-12-31$944
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$118,633
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$155
Total non interest bearing cash at end of year2018-12-31$368
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$276,938
Value of net assets at end of year (total assets less liabilities)2018-12-31$6,128,824
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$5,851,886
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$252
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$0
Value of interest in pooled separate accounts at end of year2018-12-31$5,936,371
Value of interest in pooled separate accounts at beginning of year2018-12-31$5,767,523
Interest on participant loans2018-12-31$7,483
Net investment gain/loss from pooled separate accounts2018-12-31$-435,689
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$218,933
Employer contributions (assets) at end of year2018-12-31$0
Employer contributions (assets) at beginning of year2018-12-31$544
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$210,901
Contract administrator fees2018-12-31$1,950
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 name2018-12-31CARON & BLETZER, PLLC
Accountancy firm EIN2018-12-31043499945
2017 : FIVOS, INC. 401(K) PLAN 2017 401k financial data
Total income from all sources (including contributions)2017-12-31$1,859,427
Total of all expenses incurred2017-12-31$500,858
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$499,160
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$1,005,133
Value of total assets at end of year2017-12-31$5,851,886
Value of total assets at beginning of year2017-12-31$4,493,317
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$1,698
Total interest from all sources2017-12-31$3,604
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$250,000
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$423,039
Participant contributions at end of year2017-12-31$82,875
Participant contributions at beginning of year2017-12-31$30,637
Participant contributions at end of year2017-12-31$944
Participant contributions at beginning of year2017-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$403,871
Administrative expenses (other) incurred2017-12-31$1,500
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$1,358,569
Value of net assets at end of year (total assets less liabilities)2017-12-31$5,851,886
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$4,493,317
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$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$0
Value of interest in pooled separate accounts at end of year2017-12-31$5,767,523
Value of interest in pooled separate accounts at beginning of year2017-12-31$4,462,336
Interest on participant loans2017-12-31$3,604
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$0
Net investment gain/loss from pooled separate accounts2017-12-31$850,690
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31Yes
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$178,223
Employer contributions (assets) at end of year2017-12-31$544
Employer contributions (assets) at beginning of year2017-12-31$344
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$499,160
Contract administrator fees2017-12-31$198
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 name2017-12-31CARON & BLETZER, PLLC
Accountancy firm EIN2017-12-31043499945

Form 5500 Responses for FIVOS, INC. 401(K) PLAN

2023: FIVOS, INC. 401(K) PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – TrustYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement - TrustYes
2022: FIVOS, INC. 401(K) 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: FIVOS, INC. 401(K) 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: FIVOS, INC. 401(K) 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: FIVOS, INC. 401(K) 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: FIVOS, INC. 401(K) 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: FIVOS, INC. 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number1261284-01
Policy instance 1
Insurance contract or identification number1261284-01
Number of Individuals Covered6
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number1261284-01
Policy instance 1
Insurance contract or identification number1261284-01
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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number
Policy instance 1
Number of Individuals Covered107
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $37,176
Amount paid for insurance broker fees23878
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?7
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number
Policy instance 1
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $32,576
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees20169
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?7
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number
Policy instance 1
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $26,247
Amount paid for insurance broker fees17926
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?7
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number
Policy instance 1
Number of Individuals Covered99
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $22,938
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees15488
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?7
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number
Policy instance 1
Number of Individuals Covered94
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $17,646
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees13454
Additional information about fees paid to insurance brokerBROKER COMMISSION
Insurance broker organization code?7
Insurance broker nameTHE PENSION SERVICE

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