401k Plan data: CNA/SETON RETIREMENT PLAN plan

CNA/SETON RETIREMENT PLAN 401k Plan overview

Plan Name	CNA/SETON RETIREMENT PLAN
Plan identification number	009

CNA/SETON RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Money purchase (other than target benefit)
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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
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

VERITY HEALTH SYSTEM has sponsored the creation of one or more 401k plans.

Company Name: VERITY HEALTH SYSTEM

Employer identification number (EIN): 912145484

NAIC Classification: 622000
NAIC Description: Hospitals

Additional information about VERITY HEALTH SYSTEM

Jurisdiction of Incorporation: California Department of State

Incorporation Date:

Company Identification Number: C2346440

More information about VERITY HEALTH SYSTEM

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CNA/SETON RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
009 2020-01-01 PETER CHADWICK 2021-03-15 PETER CHADWICK 2021-03-15
009 2019-01-01 PETER CHADWICK 2020-07-09 PETER CHADWICK 2020-07-09
009 2018-01-01 STEVE SHARRER 2019-10-10 STEVE SHARRER 2019-10-10
009 2017-01-01
009 2016-01-01 STEVE SHARRER 2018-10-10
009 2015-12-14 STEVE SHARRER 2018-10-10

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
009	2020-01-01	PETER CHADWICK	2021-03-15	PETER CHADWICK	2021-03-15
009	2019-01-01	PETER CHADWICK	2020-07-09	PETER CHADWICK	2020-07-09
009	2018-01-01	STEVE SHARRER	2019-10-10	STEVE SHARRER	2019-10-10
009	2017-01-01
009	2016-01-01	STEVE SHARRER	2018-10-10
009	2015-12-14	STEVE SHARRER	2018-10-10

Plan Statistics for CNA/SETON RETIREMENT PLAN

401k plan membership statisitcs for CNA/SETON RETIREMENT PLAN

Measure Date Value
2020: CNA/SETON RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 0
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 0
Number of participants with account balances 2020-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 0
2019: CNA/SETON RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 161
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 42
Number of retired or separated participants receiving benefits 2019-01-01 2
Number of other retired or separated participants entitled to future benefits 2019-01-01 92
Total of all active and inactive participants 2019-01-01 136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 5
Total participants 2019-01-01 141
Number of participants with account balances 2019-01-01 141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: CNA/SETON RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 170
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 53
Number of retired or separated participants receiving benefits 2018-01-01 6
Number of other retired or separated participants entitled to future benefits 2018-01-01 102
Total of all active and inactive participants 2018-01-01 161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 161
Number of participants with account balances 2018-01-01 161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: CNA/SETON RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 175
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 64
Number of retired or separated participants receiving benefits 2017-01-01 4
Number of other retired or separated participants entitled to future benefits 2017-01-01 102
Total of all active and inactive participants 2017-01-01 170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 170
Number of participants with account balances 2017-01-01 170
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: CNA/SETON RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 182
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 71
Number of retired or separated participants receiving benefits 2016-01-01 4
Number of other retired or separated participants entitled to future benefits 2016-01-01 100
Total of all active and inactive participants 2016-01-01 175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 175
Number of participants with account balances 2016-01-01 175
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: CNA/SETON RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-12-14 184
Total number of active participants reported on line 7a of the Form 5500 2015-12-14 80
Number of retired or separated participants receiving benefits 2015-12-14 3
Number of other retired or separated participants entitled to future benefits 2015-12-14 99
Total of all active and inactive participants 2015-12-14 182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-12-14 0
Total participants 2015-12-14 182
Number of participants with account balances 2015-12-14 182
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-12-14 0

Measure	Date	Value
2020: CNA/SETON RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	0
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	0
Number of participants with account balances	2020-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	0
2019: CNA/SETON RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	161
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	42
Number of retired or separated participants receiving benefits	2019-01-01	2
Number of other retired or separated participants entitled to future benefits	2019-01-01	92
Total of all active and inactive participants	2019-01-01	136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	5
Total participants	2019-01-01	141
Number of participants with account balances	2019-01-01	141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: CNA/SETON RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	170
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	53
Number of retired or separated participants receiving benefits	2018-01-01	6
Number of other retired or separated participants entitled to future benefits	2018-01-01	102
Total of all active and inactive participants	2018-01-01	161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	161
Number of participants with account balances	2018-01-01	161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: CNA/SETON RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	175
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	64
Number of retired or separated participants receiving benefits	2017-01-01	4
Number of other retired or separated participants entitled to future benefits	2017-01-01	102
Total of all active and inactive participants	2017-01-01	170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	170
Number of participants with account balances	2017-01-01	170
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: CNA/SETON RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	182
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	71
Number of retired or separated participants receiving benefits	2016-01-01	4
Number of other retired or separated participants entitled to future benefits	2016-01-01	100
Total of all active and inactive participants	2016-01-01	175
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	175
Number of participants with account balances	2016-01-01	175
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: CNA/SETON RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-12-14	184
Total number of active participants reported on line 7a of the Form 5500	2015-12-14	80
Number of retired or separated participants receiving benefits	2015-12-14	3
Number of other retired or separated participants entitled to future benefits	2015-12-14	99
Total of all active and inactive participants	2015-12-14	182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-12-14	0
Total participants	2015-12-14	182
Number of participants with account balances	2015-12-14	182
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-12-14	0

Financial Data on CNA/SETON RETIREMENT PLAN

Measure	Date	Value
2020 : CNA/SETON RETIREMENT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-11-24	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-11-24	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-11-24	$0
Total income from all sources (including contributions)	2020-11-24	$250,967
Total loss/gain on sale of assets	2020-11-24	$0
Total of all expenses incurred	2020-11-24	$4,149,687
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-11-24	$4,149,695
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-11-24	$0
Value of total assets at end of year	2020-11-24	$0
Value of total assets at beginning of year	2020-11-24	$3,898,720
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-11-24	$-8
Total interest from all sources	2020-11-24	$29,001
Total dividends received (eg from common stock, registered investment company shares)	2020-11-24	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-11-24	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2020-11-24	$0
Was this plan covered by a fidelity bond	2020-11-24	Yes
Value of fidelity bond cover	2020-11-24	$10,000,000
If this is an individual account plan, was there a blackout period	2020-11-24	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-11-24	$0
Were there any nonexempt tranactions with any party-in-interest	2020-11-24	No
Administrative expenses (other) incurred	2020-11-24	$-8
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-11-24	No
Value of net income/loss	2020-11-24	$-3,898,720
Value of net assets at end of year (total assets less liabilities)	2020-11-24	$0
Value of net assets at beginning of year (total assets less liabilities)	2020-11-24	$3,898,720
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-11-24	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-11-24	No
Were any leases to which the plan was party in default or uncollectible	2020-11-24	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-11-24	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-11-24	$2,386,871
Interest on participant loans	2020-11-24	$91
Interest earned on other investments	2020-11-24	$28,910
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-11-24	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-11-24	$1,511,849
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-11-24	$221,966
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-11-24	No
Was there a failure to transmit to the plan any participant contributions	2020-11-24	No
Has the plan failed to provide any benefit when due under the plan	2020-11-24	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-11-24	$4,149,695
Did the plan have assets held for investment	2020-11-24	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-11-24	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-11-24	Yes
Opinion of an independent qualified public accountant for this plan	2020-11-24	Disclaimer
Accountancy firm name	2020-11-24	MOSS ADAMS LLP
Accountancy firm EIN	2020-11-24	910189318
2019 : CNA/SETON RETIREMENT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$645,896
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$1,174,038
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,179,588
Expenses. Certain deemed distributions of participant loans	2019-12-31	$-5,550
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$0
Value of total assets at end of year	2019-12-31	$3,898,720
Value of total assets at beginning of year	2019-12-31	$4,426,862
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$0
Total interest from all sources	2019-12-31	$56,902
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$45,214
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2019-12-31	$30,965
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$-528,142
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$3,898,720
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$4,426,862
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$2,386,871
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$2,309,763
Interest on participant loans	2019-12-31	$1,006
Interest earned on other investments	2019-12-31	$55,896
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$1,511,849
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$2,071,885
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$588,994
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,148,623
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2019-12-31	910189318
2018 : CNA/SETON RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$-110,081
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$462,969
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$458,896
Expenses. Certain deemed distributions of participant loans	2018-12-31	$4,073
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$0
Value of total assets at end of year	2018-12-31	$4,426,862
Value of total assets at beginning of year	2018-12-31	$4,999,912
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$0
Total interest from all sources	2018-12-31	$60,290
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Participant contributions at end of year	2018-12-31	$45,214
Participant contributions at beginning of year	2018-12-31	$51,498
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-573,050
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$4,426,862
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$4,999,912
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$2,309,763
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$3,028,504
Interest on participant loans	2018-12-31	$1,470
Interest earned on other investments	2018-12-31	$58,820
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$2,071,885
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$1,919,910
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-170,371
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$458,896
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2018-12-31	910189318
2017 : CNA/SETON RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$0
Expenses. Interest paid	2017-12-31	$-1,650
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2017-12-31	$-1,650
Total income from all sources (including contributions)	2017-12-31	$578,087
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$220,030
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$221,680
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$0
Value of total assets at end of year	2017-12-31	$4,999,912
Value of total assets at beginning of year	2017-12-31	$4,641,855
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$0
Total interest from all sources	2017-12-31	$60,551
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2017-12-31	$0
Minimum employer required contribution for this plan year	2017-12-31	$0
Amount contributed by the employer to the plan for this plan year	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$0
Participant contributions at end of year	2017-12-31	$51,498
Participant contributions at beginning of year	2017-12-31	$78,998
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2017-12-31	$686
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$358,057
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$4,999,912
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$4,641,855
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$3,028,504
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$2,577,905
Interest on participant loans	2017-12-31	$1,880
Interest earned on other investments	2017-12-31	$58,671
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$1,919,910
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$1,984,952
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$517,536
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$220,994
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2017-12-31	910189318
2016 : CNA/SETON RETIREMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$264,499
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$460,272
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$462,901
Expenses. Certain deemed distributions of participant loans	2016-12-31	$-2,629
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$0
Value of total assets at end of year	2016-12-31	$4,641,855
Value of total assets at beginning of year	2016-12-31	$4,837,628
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$0
Total interest from all sources	2016-12-31	$61,095
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$0
Participant contributions at end of year	2016-12-31	$78,998
Participant contributions at beginning of year	2016-12-31	$62,519
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2016-12-31	$2,990
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-195,773
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$4,641,855
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$4,837,628
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$2,577,905
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$2,751,953
Interest on participant loans	2016-12-31	$2,144
Interest earned on other investments	2016-12-31	$58,951
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$1,984,952
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$2,023,156
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$203,404
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$459,911
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2016-12-31	910189318
2015 : CNA/SETON RETIREMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$0
Total income from all sources (including contributions)	2015-12-31	$-63,824
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$104,255
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$104,255
Expenses. Certain deemed distributions of participant loans	2015-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$0
Value of total assets at end of year	2015-12-31	$4,837,628
Value of total assets at beginning of year	2015-12-31	$5,005,707
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$0
Total interest from all sources	2015-12-31	$5,277
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$10,000,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$0
Participant contributions at end of year	2015-12-31	$62,519
Participant contributions at beginning of year	2015-12-31	$63,283
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-168,079
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$4,837,628
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$5,005,707
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$2,751,953
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$2,887,197
Interest on participant loans	2015-12-31	$154
Interest earned on other investments	2015-12-31	$5,123
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$2,023,156
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$2,055,227
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-69,101
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$104,255
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No

Form 5500 Responses for CNA/SETON RETIREMENT PLAN

2020: CNA/SETON RETIREMENT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	Yes
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: CNA/SETON RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: CNA/SETON RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: CNA/SETON RETIREMENT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: CNA/SETON RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CNA/SETON RETIREMENT PLAN 2015 form 5500 responses
2015-12-14	Type of plan entity	Single employer plan
2015-12-14	First time form 5500 has been submitted	Yes
2015-12-14	Submission has been amended	No
2015-12-14	This submission is the final filing	No
2015-12-14	This return/report is a short plan year return/report (less than 12 months)	Yes
2015-12-14	Plan is a collectively bargained plan	No
2015-12-14	Plan funding arrangement – Insurance	Yes
2015-12-14	Plan funding arrangement – Trust	Yes
2015-12-14	Plan benefit arrangement – Insurance	Yes
2015-12-14	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

31000

Policy instance

Insurance contract or identification number	31000
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-11-24
Total amount of commissions paid to insurance broker	USD $386
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $315
Insurance broker organization code?	3

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

31000

Policy instance

Insurance contract or identification number	31000
Number of Individuals Covered	0
Insurance policy start date	2020-01-01
Insurance policy end date	2020-11-24
Total amount of commissions paid to insurance broker	USD $223
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $183
Insurance broker organization code?	3

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

31000

Policy instance

Insurance contract or identification number	31000
Number of Individuals Covered	110
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $391
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $326
Insurance broker organization code?	3

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

31000

Policy instance

Insurance contract or identification number	31000
Number of Individuals Covered	79
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $755
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $620
Insurance broker organization code?	3

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

31000

Policy instance

Insurance contract or identification number	31000
Number of Individuals Covered	95
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $812
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $693
Insurance broker organization code?	3

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

31000

Policy instance

Insurance contract or identification number	31000
Number of Individuals Covered	129
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $454
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $381
Insurance broker organization code?	3

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

31000

Policy instance

Insurance contract or identification number	31000
Number of Individuals Covered	138
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $510
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $417
Insurance broker organization code?	3
Insurance broker name	CREECH, JOHN D

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )

Policy contract number

31000

Policy instance

Insurance contract or identification number	31000
Number of Individuals Covered	100
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $866
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	1
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $733
Insurance broker organization code?	3
Insurance broker name	LEE, JOHN S

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Company Name:	VERITY HEALTH SYSTEM
Employer identification number (EIN):	912145484
NAIC Classification:	622000
NAIC Description:	Hospitals

Jurisdiction of Incorporation:	California Department of State
Incorporation Date:
Company Identification Number:	C2346440