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JOHNSON OIL CO. 401(K) PLAN 401k Plan overview

Plan NameJOHNSON OIL CO. 401(K) PLAN
Plan identification number 002

JOHNSON OIL CO. 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.
  • 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.

401k Sponsoring company profile

CAREY JOHNSON OIL CO., INC. has sponsored the creation of one or more 401k plans.

Company Name:CAREY JOHNSON OIL CO., INC.
Employer identification number (EIN):730777706
NAIC Classification:447100
NAIC Description: Gasoline Stations, Gas

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOHNSON OIL CO. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022023-01-01
0022022-01-01
0022021-01-01
0022020-01-01
0022020-01-01

Plan Statistics for JOHNSON OIL CO. 401(K) PLAN

401k plan membership statisitcs for JOHNSON OIL CO. 401(K) PLAN

Measure Date Value
2023: JOHNSON OIL CO. 401(K) PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01286
Total number of active participants reported on line 7a of the Form 55002023-01-0139
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-0139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2023-01-010
Total participants2023-01-0139
Number of participants with account balances2023-01-0139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2023-01-010
2022: JOHNSON OIL CO. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01299
Total number of active participants reported on line 7a of the Form 55002022-01-01120
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0115
Total of all active and inactive participants2022-01-01135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01135
Number of participants with account balances2022-01-01135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0158
2021: JOHNSON OIL CO. 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01279
Total number of active participants reported on line 7a of the Form 55002021-01-01100
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0155
Total of all active and inactive participants2021-01-01155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01155
Number of participants with account balances2021-01-01155
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-0126
2020: JOHNSON OIL CO. 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01308
Total number of active participants reported on line 7a of the Form 55002020-01-01168
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0159
Total of all active and inactive participants2020-01-01227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01227
Number of participants with account balances2020-01-01160
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0110

Financial Data on JOHNSON OIL CO. 401(K) PLAN

Measure Date Value
2023 : JOHNSON OIL CO. 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$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Total income from all sources (including contributions)2023-12-31$761,028
Total loss/gain on sale of assets2023-12-31$0
Total of all expenses incurred2023-12-31$2,970,764
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$2,870,258
Expenses. Certain deemed distributions of participant loans2023-12-31$52,399
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$242,648
Value of total assets at end of year2023-12-31$3,251,563
Value of total assets at beginning of year2023-12-31$5,461,299
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$48,107
Total interest from all sources2023-12-31$9,442
Total dividends received (eg from common stock, registered investment company shares)2023-12-31$111,900
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$111,900
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$142,332
Participant contributions at end of year2023-12-31$28,823
Participant contributions at beginning of year2023-12-31$269,895
Participant contributions at beginning of year2023-12-31$10,783
Income. Received or receivable in cash from other sources (including rollovers)2023-12-31$39,505
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Value of net income/loss2023-12-31$-2,209,736
Value of net assets at end of year (total assets less liabilities)2023-12-31$3,251,563
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$5,461,299
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$3,068,111
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-12-31$4,213,567
Interest on participant loans2023-12-31$9,442
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2023-12-31$154,629
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2023-12-31$961,228
Net investment gain/loss from registered investment companies (e.g. mutual funds)2023-12-31$397,038
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 contributions2023-12-31No
Has the plan failed to provide any benefit when due under the plan2023-12-31No
Contributions received in cash from employer2023-12-31$60,811
Employer contributions (assets) at beginning of year2023-12-31$5,826
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-12-31$2,870,258
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 name2023-12-31EIDE BAILLY, LLP
Accountancy firm EIN2023-12-31450250958
2022 : JOHNSON OIL CO. 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$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-436,260
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$272,814
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$233,298
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$427,759
Value of total assets at end of year2022-12-31$5,461,299
Value of total assets at beginning of year2022-12-31$6,170,373
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$39,516
Total interest from all sources2022-12-31$11,402
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$145,147
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$145,147
Administrative expenses professional fees incurred2022-12-31$35,591
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$279,503
Participant contributions at end of year2022-12-31$269,895
Participant contributions at beginning of year2022-12-31$190,967
Participant contributions at end of year2022-12-31$10,783
Total non interest bearing cash at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-709,074
Value of net assets at end of year (total assets less liabilities)2022-12-31$5,461,299
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$6,170,373
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$4,213,567
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$5,024,067
Interest on participant loans2022-12-31$11,207
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$195
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$961,228
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$955,339
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-1,020,568
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 contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$148,256
Employer contributions (assets) at end of year2022-12-31$5,826
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$233,298
Contract administrator fees2022-12-31$3,925
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 name2022-12-31EIDE BAILLY, LLP
Accountancy firm EIN2022-12-31450250958
2021 : JOHNSON OIL CO. 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
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$1,011,590
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$746,565
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$695,589
Expenses. Certain deemed distributions of participant loans2021-12-31$9,550
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$394,519
Value of total assets at end of year2021-12-31$6,170,373
Value of total assets at beginning of year2021-12-31$5,905,348
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$41,426
Total interest from all sources2021-12-31$7,542
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$376,338
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$376,338
Administrative expenses professional fees incurred2021-12-31$3,961
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$269,903
Participant contributions at end of year2021-12-31$190,967
Participant contributions at beginning of year2021-12-31$153,243
Participant contributions at beginning of year2021-12-31$9,331
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$544
Total non interest bearing cash at end of year2021-12-31$0
Total non interest bearing cash at beginning of year2021-12-31$4,825
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$265,025
Value of net assets at end of year (total assets less liabilities)2021-12-31$6,170,373
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$5,905,348
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$5,024,067
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$4,867,033
Interest on participant loans2021-12-31$7,542
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$955,339
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$866,368
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$233,191
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 contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$124,072
Employer contributions (assets) at beginning of year2021-12-31$4,548
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$695,589
Contract administrator fees2021-12-31$37,465
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 name2021-12-31EIDE BAILLY, LLP
Accountancy firm EIN2021-12-31450250958
2020 : JOHNSON OIL CO. 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
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$1,312,613
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$223,503
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$190,024
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$393,895
Value of total assets at end of year2020-12-31$5,905,348
Value of total assets at beginning of year2020-12-31$4,816,238
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$33,479
Total interest from all sources2020-12-31$11,133
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$147,502
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$147,502
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$268,352
Participant contributions at end of year2020-12-31$153,243
Participant contributions at beginning of year2020-12-31$207,980
Participant contributions at end of year2020-12-31$9,331
Total non interest bearing cash at end of year2020-12-31$4,825
Total non interest bearing cash at beginning of year2020-12-31$7,830
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$1,089,110
Value of net assets at end of year (total assets less liabilities)2020-12-31$5,905,348
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$4,816,238
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$4,867,033
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$3,882,737
Interest on participant loans2020-12-31$11,133
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$866,368
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$717,691
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$760,083
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$125,543
Employer contributions (assets) at end of year2020-12-31$4,548
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$190,024
Contract administrator fees2020-12-31$33,479
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 name2020-12-31EIDE BAILLY, LLC
Accountancy firm EIN2020-12-31450250958

Form 5500 Responses for JOHNSON OIL CO. 401(K) PLAN

2023: JOHNSON OIL CO. 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: JOHNSON OIL CO. 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: JOHNSON OIL CO. 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: JOHNSON OIL CO. 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedYes
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

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number375358.01
Policy instance 1
Insurance contract or identification number375358.01
Number of Individuals Covered10
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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?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 number375358.01
Policy instance 1
Insurance contract or identification number375358.01
Number of Individuals Covered25
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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?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 number375358.01
Policy instance 1
Insurance contract or identification number375358.01
Number of Individuals Covered30
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 $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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number375358.01
Policy instance 1
Insurance contract or identification number375358.01
Number of Individuals Covered29
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 $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

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