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QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN 401k Plan overview

Plan NameQUALITY CORRECTIONAL CARE, LLC 401(K) PLAN
Plan identification number 001

QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN Benefits

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

QUALITY CORRECTIONAL CARE has sponsored the creation of one or more 401k plans.

Company Name:QUALITY CORRECTIONAL CARE
Employer identification number (EIN):453708550
NAIC Classification:621399
NAIC Description:Offices of All Other Miscellaneous Health Practitioners

Additional information about QUALITY CORRECTIONAL CARE

Jurisdiction of Incorporation: Indiana Secretary of State
Incorporation Date:
Company Identification Number: 011110400442

More information about QUALITY CORRECTIONAL CARE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01LISA SCROGGINS2024-10-15
0012022-01-01LISA SCROGGINS2023-10-16
0012021-01-01
0012021-01-01
0012020-01-01
0012019-01-01LISA SCROGGINS2020-09-29 LISA SCROGGINS2020-09-29
0012018-01-01LISA SCROGGINS2019-10-08 LISA SCROGGINS2019-10-08
0012017-01-01LISA SCROGGINS2018-10-04 LISA SCROGGINS2018-10-04
0012016-01-01LISA SCROGGINS2017-09-05 LISA SCROGGINS2017-09-05

Plan Statistics for QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN

401k plan membership statisitcs for QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN

Measure Date Value
2023: QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01358
Total number of active participants reported on line 7a of the Form 55002023-01-01283
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-0156
Total of all active and inactive participants2023-01-01339
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2023-01-010
Total participants2023-01-01339
Number of participants with account balances2023-01-01169
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2023-01-010
2022: QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01310
Total number of active participants reported on line 7a of the Form 55002022-01-01260
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0156
Total of all active and inactive participants2022-01-01316
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01316
Number of participants with account balances2022-01-01146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01251
Total number of active participants reported on line 7a of the Form 55002021-01-01236
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0136
Total of all active and inactive participants2021-01-01272
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01272
Number of participants with account balances2021-01-01135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01224
Total number of active participants reported on line 7a of the Form 55002020-01-01219
Number of retired or separated participants receiving benefits2020-01-019
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01228
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01228
Number of participants with account balances2020-01-0194
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010

Financial Data on QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN

Measure Date Value
2023 : QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN 2023 401k financial data
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$3,861
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$3,841
Total income from all sources (including contributions)2023-12-31$1,365,007
Total loss/gain on sale of assets2023-12-31$0
Total of all expenses incurred2023-12-31$497,110
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$462,546
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$897,713
Value of total assets at end of year2023-12-31$3,385,010
Value of total assets at beginning of year2023-12-31$2,517,093
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$34,564
Total interest from all sources2023-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2023-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-12-31No
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 period2023-12-31Yes
Were there any nonexempt tranactions with any party-in-interest2023-12-31No
Contributions received from participants2023-12-31$487,733
Participant contributions at end of year2023-12-31$20,598
Participant contributions at beginning of year2023-12-31$17,332
Income. Received or receivable in cash from other sources (including rollovers)2023-12-31$87,335
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-12-31$3,861
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-12-31$3,841
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
Value of net income/loss2023-12-31$867,897
Value of net assets at end of year (total assets less liabilities)2023-12-31$3,381,149
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$2,513,252
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2023-12-31$3,352,031
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-12-31$2,486,507
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2023-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2023-12-31$1,091
Net investment gain/loss from registered investment companies (e.g. mutual funds)2023-12-31$467,294
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
Contributions received in cash from employer2023-12-31$322,645
Employer contributions (assets) at end of year2023-12-31$12,381
Employer contributions (assets) at beginning of year2023-12-31$12,163
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-12-31$462,546
Contract administrator fees2023-12-31$34,564
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32023-12-31Yes
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
Opinion of an independent qualified public accountant for this plan2023-12-31Unqualified
Accountancy firm name2023-12-31CBIZ CPAS P.C.
Accountancy firm EIN2023-12-31431947695
2022 : QUALITY CORRECTIONAL CARE, LLC 401(K) 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$3,841
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$486,157
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$355,803
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$315,429
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$886,778
Value of total assets at end of year2022-12-31$2,517,093
Value of total assets at beginning of year2022-12-31$2,382,898
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$40,374
Total interest from all sources2022-12-31$0
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$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$410,622
Participant contributions at end of year2022-12-31$17,332
Participant contributions at beginning of year2022-12-31$33,686
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$181,751
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$3,841
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$130,354
Value of net assets at end of year (total assets less liabilities)2022-12-31$2,513,252
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$2,382,898
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$40,374
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$2,486,507
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$2,328,689
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$1,091
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$687
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-400,621
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$294,405
Employer contributions (assets) at end of year2022-12-31$12,163
Employer contributions (assets) at beginning of year2022-12-31$19,836
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$315,429
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 plan2022-12-31Unqualified
Accountancy firm name2022-12-31DONOVAN P.C.
Accountancy firm EIN2022-12-31351356555
2021 : QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN 2021 401k financial data
Total income from all sources (including contributions)2021-12-31$963,553
Total of all expenses incurred2021-12-31$181,899
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$147,215
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$681,653
Value of total assets at end of year2021-12-31$2,382,898
Value of total assets at beginning of year2021-12-31$1,601,244
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$34,684
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 bond2021-12-31No
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$392,315
Participant contributions at end of year2021-12-31$33,686
Participant contributions at beginning of year2021-12-31$12,574
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$9,495
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$781,654
Value of net assets at end of year (total assets less liabilities)2021-12-31$2,382,898
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,601,244
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$4,277
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$2,328,689
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$1,581,112
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$687
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$2,465
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$281,900
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$279,843
Employer contributions (assets) at end of year2021-12-31$19,836
Employer contributions (assets) at beginning of year2021-12-31$5,093
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$147,215
Contract administrator fees2021-12-31$30,407
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 name2021-12-31DONOVAN P.C.
Accountancy firm EIN2021-12-31351356555
2020 : QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN 2020 401k financial data
Total income from all sources (including contributions)2020-12-31$785,599
Total of all expenses incurred2020-12-31$104,011
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$75,836
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$575,718
Value of total assets at end of year2020-12-31$1,601,244
Value of total assets at beginning of year2020-12-31$919,656
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$28,175
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 bond2020-12-31No
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$309,839
Participant contributions at end of year2020-12-31$12,574
Participant contributions at beginning of year2020-12-31$904
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$37,129
Administrative expenses (other) incurred2020-12-31$4,255
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$681,588
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,601,244
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$919,656
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$23,920
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$1,581,112
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$915,380
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$2,465
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$1,548
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$209,881
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$228,750
Employer contributions (assets) at end of year2020-12-31$5,093
Employer contributions (assets) at beginning of year2020-12-31$1,824
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$75,836
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 plan2020-12-31Disclaimer
Accountancy firm name2020-12-31DONOVAN CPAS
Accountancy firm EIN2020-12-31351356555

Form 5500 Responses for QUALITY CORRECTIONAL CARE, LLC 401(K) PLAN

2023: QUALITY CORRECTIONAL CARE, LLC 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: QUALITY CORRECTIONAL CARE, LLC 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: QUALITY CORRECTIONAL CARE, LLC 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: QUALITY CORRECTIONAL CARE, LLC 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

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number194-80610
Policy instance 1
Insurance contract or identification number194-80610
Number of Individuals Covered339
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
Total amount of commissions paid to insurance brokerUSD $1
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?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 number194-80610
Policy instance 1
Insurance contract or identification number194-80610
Number of Individuals Covered316
Insurance policy start date2022-11-28
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1
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?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 $1
Amount paid for insurance broker fees0
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-JJ2P
Policy instance 1
Insurance contract or identification numberGAP-CP-JJ2P
Number of Individuals Covered2
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $17
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type 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 $17
Amount paid for insurance broker fees0
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-JJ2P
Policy instance 1
Insurance contract or identification numberGAP-CP-JJ2P
Number of Individuals Covered1
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $20
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type 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 $20
Amount paid for insurance broker fees0
Insurance broker organization code?3

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