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DR. WILLIAM L. HARRISION RETIREMENT PLAN 401k Plan overview

Plan NameDR. WILLIAM L. HARRISION RETIREMENT PLAN
Plan identification number 001

DR. WILLIAM L. HARRISION RETIREMENT 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.
  • 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

WILLIAM L. HARRISION has sponsored the creation of one or more 401k plans.

Company Name:WILLIAM L. HARRISION
Employer identification number (EIN):870489203
NAIC Classification:621320
NAIC Description:Offices of Optometrists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DR. WILLIAM L. HARRISION RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012021-01-01JOSEPH OLSON2021-09-07
0012020-01-01JOSEPH OLSON2021-06-07
0012019-01-01
0012018-01-01JOSEPH OLSON
0012017-01-01WILLIAM HARRISON
0012016-01-01WILLIAM HARRISON
0012015-01-01WILLIAM L HARRISON WILLIAM L HARRISON2016-05-27
0012014-01-01WILLIAM HARRISON WILLIAM HARRISON2015-05-14
0012013-01-01WILLIAM HARRISON WILLIAM HARRISON2014-06-09
0012012-01-01WILLIAM HARRISON WILLIAM HARRISON2013-05-21
0012011-01-01WILLIAM HARRISON WILLIAM HARRISON2012-06-04

Plan Statistics for DR. WILLIAM L. HARRISION RETIREMENT PLAN

401k plan membership statisitcs for DR. WILLIAM L. HARRISION RETIREMENT PLAN

Measure Date Value
2019: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-017
Total number of active participants reported on line 7a of the Form 55002019-01-013
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-013
Total of all active and inactive participants2019-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-016
Number of participants with account balances2019-01-014
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-018
Total number of active participants reported on line 7a of the Form 55002018-01-015
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-012
Total of all active and inactive participants2018-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-017
Number of participants with account balances2018-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-018
Total number of active participants reported on line 7a of the Form 55002017-01-014
Number of retired or separated participants receiving benefits2017-01-012
Number of other retired or separated participants entitled to future benefits2017-01-012
Total of all active and inactive participants2017-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-018
Number of participants with account balances2017-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-018
Total number of active participants reported on line 7a of the Form 55002016-01-017
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-011
Total of all active and inactive participants2016-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-018
Number of participants with account balances2016-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-017
Total number of active participants reported on line 7a of the Form 55002015-01-016
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-011
Total of all active and inactive participants2015-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-017
Number of participants with account balances2015-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-017
Total number of active participants reported on line 7a of the Form 55002014-01-016
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-011
Total of all active and inactive participants2014-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-017
Number of participants with account balances2014-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-017
Total number of active participants reported on line 7a of the Form 55002013-01-016
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-011
Total of all active and inactive participants2013-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-017
Number of participants with account balances2013-01-017
2012: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-016
Total number of active participants reported on line 7a of the Form 55002012-01-017
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-017
Number of participants with account balances2012-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-016
Total number of active participants reported on line 7a of the Form 55002011-01-016
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-016
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-016
Number of participants with account balances2011-01-016
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010

Financial Data on DR. WILLIAM L. HARRISION RETIREMENT PLAN

Measure Date Value
2019 : DR. WILLIAM L. HARRISION RETIREMENT PLAN 2019 401k financial data
Total income from all sources2019-12-31$60,090
Expenses. Total of all expenses incurred2019-12-31$787,703
Benefits paid (including direct rollovers)2019-12-31$787,598
Total plan assets at end of year2019-12-31$21,592
Total plan assets at beginning of year2019-12-31$749,205
Value of fidelity bond covering the plan2019-12-31$125,000
Total contributions received or receivable from participants2019-12-31$3,438
Other income received2019-12-31$54,656
Net income (gross income less expenses)2019-12-31$-727,613
Net plan assets at end of year (total assets less liabilities)2019-12-31$21,592
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$749,205
Total contributions received or receivable from employer(s)2019-12-31$1,996
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$105
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : DR. WILLIAM L. HARRISION RETIREMENT PLAN 2018 401k financial data
Total income from all sources2018-12-31$-49,894
Expenses. Total of all expenses incurred2018-12-31$419,090
Benefits paid (including direct rollovers)2018-12-31$412,119
Total plan assets at end of year2018-12-31$749,205
Total plan assets at beginning of year2018-12-31$1,218,189
Value of fidelity bond covering the plan2018-12-31$125,000
Total contributions received or receivable from participants2018-12-31$38,580
Expenses. Other expenses not covered elsewhere2018-12-31$6,971
Other income received2018-12-31$-91,819
Net income (gross income less expenses)2018-12-31$-468,984
Net plan assets at end of year (total assets less liabilities)2018-12-31$749,205
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$1,218,189
Total contributions received or receivable from employer(s)2018-12-31$3,345
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : DR. WILLIAM L. HARRISION RETIREMENT PLAN 2017 401k financial data
Total income from all sources2017-12-31$200,160
Expenses. Total of all expenses incurred2017-12-31$88,744
Benefits paid (including direct rollovers)2017-12-31$82,204
Total plan assets at end of year2017-12-31$1,218,189
Total plan assets at beginning of year2017-12-31$1,106,773
Value of fidelity bond covering the plan2017-12-31$125,000
Total contributions received or receivable from participants2017-12-31$49,920
Other income received2017-12-31$146,647
Net income (gross income less expenses)2017-12-31$111,416
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,218,189
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$1,106,773
Total contributions received or receivable from employer(s)2017-12-31$3,593
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$6,540
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : DR. WILLIAM L. HARRISION RETIREMENT PLAN 2016 401k financial data
Total income from all sources2016-12-31$132,820
Expenses. Total of all expenses incurred2016-12-31$2,822
Total plan assets at end of year2016-12-31$1,106,773
Total plan assets at beginning of year2016-12-31$976,775
Value of fidelity bond covering the plan2016-12-31$115,000
Total contributions received or receivable from participants2016-12-31$48,269
Contributions received from other sources (not participants or employers)2016-12-31$24,445
Other income received2016-12-31$55,984
Net income (gross income less expenses)2016-12-31$129,998
Net plan assets at end of year (total assets less liabilities)2016-12-31$1,106,773
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$976,775
Total contributions received or receivable from employer(s)2016-12-31$4,122
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$2,822
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : DR. WILLIAM L. HARRISION RETIREMENT PLAN 2015 401k financial data
Total income from all sources2015-12-31$7,343
Expenses. Total of all expenses incurred2015-12-31$74
Total plan assets at end of year2015-12-31$976,775
Total plan assets at beginning of year2015-12-31$969,506
Value of fidelity bond covering the plan2015-12-31$100,000
Total contributions received or receivable from participants2015-12-31$48,160
Other income received2015-12-31$-44,666
Net income (gross income less expenses)2015-12-31$7,269
Net plan assets at end of year (total assets less liabilities)2015-12-31$976,775
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$969,506
Total contributions received or receivable from employer(s)2015-12-31$3,849
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$74
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : DR. WILLIAM L. HARRISION RETIREMENT PLAN 2014 401k financial data
Total income from all sources2014-12-31$78,024
Expenses. Total of all expenses incurred2014-12-31$35
Total plan assets at end of year2014-12-31$969,506
Total plan assets at beginning of year2014-12-31$891,517
Value of fidelity bond covering the plan2014-12-31$100,000
Total contributions received or receivable from participants2014-12-31$46,160
Other income received2014-12-31$28,055
Net income (gross income less expenses)2014-12-31$77,989
Net plan assets at end of year (total assets less liabilities)2014-12-31$969,506
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$891,517
Total contributions received or receivable from employer(s)2014-12-31$3,809
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$35
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : DR. WILLIAM L. HARRISION RETIREMENT PLAN 2013 401k financial data
Total income from all sources2013-12-31$214,792
Expenses. Total of all expenses incurred2013-12-31$35
Total plan assets at end of year2013-12-31$891,517
Total plan assets at beginning of year2013-12-31$676,760
Value of fidelity bond covering the plan2013-12-31$90,000
Total contributions received or receivable from participants2013-12-31$46,160
Other income received2013-12-31$164,827
Net income (gross income less expenses)2013-12-31$214,757
Net plan assets at end of year (total assets less liabilities)2013-12-31$891,517
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$676,760
Total contributions received or receivable from employer(s)2013-12-31$3,805
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$35
2012 : DR. WILLIAM L. HARRISION RETIREMENT PLAN 2012 401k financial data
Total income from all sources2012-12-31$107,243
Expenses. Total of all expenses incurred2012-12-31$35
Total plan assets at end of year2012-12-31$676,760
Total plan assets at beginning of year2012-12-31$569,552
Value of fidelity bond covering the plan2012-12-31$70,000
Total contributions received or receivable from participants2012-12-31$29,750
Other income received2012-12-31$74,234
Net income (gross income less expenses)2012-12-31$107,208
Net plan assets at end of year (total assets less liabilities)2012-12-31$676,760
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$569,552
Total contributions received or receivable from employer(s)2012-12-31$3,259
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$35
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : DR. WILLIAM L. HARRISION RETIREMENT PLAN 2011 401k financial data
Total income from all sources2011-12-31$30,263
Expenses. Total of all expenses incurred2011-12-31$35
Total plan assets at end of year2011-12-31$569,552
Total plan assets at beginning of year2011-12-31$539,324
Value of fidelity bond covering the plan2011-12-31$60,000
Total contributions received or receivable from participants2011-12-31$46,160
Other income received2011-12-31$-19,474
Net income (gross income less expenses)2011-12-31$30,228
Net plan assets at end of year (total assets less liabilities)2011-12-31$569,552
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$539,324
Total contributions received or receivable from employer(s)2011-12-31$3,577
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$35
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0

Form 5500 Responses for DR. WILLIAM L. HARRISION RETIREMENT PLAN

2019: DR. WILLIAM L. HARRISION RETIREMENT 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: DR. WILLIAM L. HARRISION RETIREMENT 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: DR. WILLIAM L. HARRISION RETIREMENT 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
2016: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: DR. WILLIAM L. HARRISION RETIREMENT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number786-80017
Policy instance 1
Insurance contract or identification number786-80017
Number of Individuals Covered1
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
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
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberE1837403
Policy instance 2
Insurance contract or identification numberE1837403
Number of Individuals Covered1
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,874
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?Yes
Commission paid to Insurance BrokerUSD $3,874
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number786-80017
Policy instance 1
Insurance contract or identification number786-80017
Number of Individuals Covered1
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
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
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract numberSEVERAL
Policy instance 2
Insurance contract or identification numberSEVERAL
Number of Individuals Covered8
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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?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?Yes
Insurance broker organization code?3
Insurance broker nameLPL FINANCIAL
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number210096825
Policy instance 1
Insurance contract or identification number210096825
Number of Individuals Covered1
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
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
Insurance broker organization code?3
Insurance broker nameDAVID BOYD WAGSTAFF
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number210096825
Policy instance 1
Insurance contract or identification number210096825
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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 group deferred annuity?Yes
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDAVID BOYD WAGSTAFF
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number210096825
Policy instance 1
Insurance contract or identification number210096825
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
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 group deferred annuity?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameDAVID BOYD WAGSTAFF
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number210096825
Policy instance 1
Insurance contract or identification number210096825
Number of Individuals Covered2
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for group deferred annuity?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameDAVID BOYD WAGSTAFF
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number210096825
Policy instance 1
Insurance contract or identification number210096825
Number of Individuals Covered7
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $467
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for group deferred annuity?Yes
Commission paid to Insurance BrokerUSD $467
Insurance broker organization code?3
Insurance broker nameDAVID BOYD WAGSTAFF
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 78778 )
Policy contract number210096825
Policy instance 1
Insurance contract or identification number210096825
Number of Individuals Covered6
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,441
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for group deferred annuity?Yes

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