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BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 401k Plan overview

Plan NameBAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT
Plan identification number 506

BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name:BAKER COMMODITIES INC
Employer identification number (EIN):952137748
NAIC Classification:311610
NAIC Description: Animal Slaughtering and Processing

Additional information about BAKER COMMODITIES INC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 2050915

More information about BAKER COMMODITIES INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5062022-01-01JEFFREY WILSON2022-09-28
5062021-01-01JEFFREY WILSON2022-08-16
5062020-01-01
5062019-01-01
5062018-01-01JEFFREY WILSON JEFFREY WILSON2019-03-27
5062017-01-01JEFFREY WILSON JEFFREY WILSON2018-04-27
5062016-01-01JEFFREY WILSON JEFFREY WILSON2017-07-24
5062015-01-01JEFFREY WILSON
5062014-01-11MITCHELL EBRIGHT MITCHELL EBRIGHT2015-08-20
5062013-01-01MITCHELL EBRIGHT MITCHELL EBRIGHT2014-08-11
5062012-01-11MITCHELL EBRIGHT MITCHELL EBRIGHT2013-05-20
5062011-01-11MITCHELL EBRIGHT
5062009-01-11MITCHELL EBRIGHT
5062009-01-11 MITCHELL EBRIGHT2010-06-09
5062009-01-11 MITCHELL EBRIGHT2010-04-16
5062009-01-01 MITCHELL EBRIGHT2010-04-12

Plan Statistics for BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT

401k plan membership statisitcs for BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT

Measure Date Value
2022: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2022 401k membership
Total participants, beginning-of-year2022-01-01255
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-010
Number of employers contributing to the scheme2022-01-010
2021: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2021 401k membership
Total participants, beginning-of-year2021-01-01213
Total number of active participants reported on line 7a of the Form 55002021-01-01255
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01255
Number of employers contributing to the scheme2021-01-010
2020: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2020 401k membership
Total participants, beginning-of-year2020-01-01213
Total number of active participants reported on line 7a of the Form 55002020-01-01213
Total of all active and inactive participants2020-01-01213
Total participants2020-01-01213
2019: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2019 401k membership
Total participants, beginning-of-year2019-01-01213
Total number of active participants reported on line 7a of the Form 55002019-01-01213
Total of all active and inactive participants2019-01-01213
Total participants2019-01-01213
2018: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2018 401k membership
Total participants, beginning-of-year2018-01-01212
Total number of active participants reported on line 7a of the Form 55002018-01-01213
Total of all active and inactive participants2018-01-01213
Total participants2018-01-01213
2017: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2017 401k membership
Total participants, beginning-of-year2017-01-01212
Total number of active participants reported on line 7a of the Form 55002017-01-01212
Total of all active and inactive participants2017-01-01212
Total participants2017-01-01212
2016: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2016 401k membership
Total participants, beginning-of-year2016-01-010
Total number of active participants reported on line 7a of the Form 55002016-01-010
Total of all active and inactive participants2016-01-010
Total participants2016-01-010
2015: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2015 401k membership
Total participants, beginning-of-year2015-01-010
Total number of active participants reported on line 7a of the Form 55002015-01-010
Total of all active and inactive participants2015-01-010
Total participants2015-01-010
2014: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2014 401k membership
Total participants, beginning-of-year2014-01-110
Total number of active participants reported on line 7a of the Form 55002014-01-110
Total of all active and inactive participants2014-01-110
Total participants2014-01-110
2013: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2013 401k membership
Total participants, beginning-of-year2013-01-01213
Total number of active participants reported on line 7a of the Form 55002013-01-010
Total of all active and inactive participants2013-01-010
Total participants2013-01-010
2012: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2012 401k membership
Total participants, beginning-of-year2012-01-11165
Total number of active participants reported on line 7a of the Form 55002012-01-11213
Total of all active and inactive participants2012-01-11213
Total participants2012-01-11213
2011: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2011 401k membership
Total participants, beginning-of-year2011-01-11171
Total number of active participants reported on line 7a of the Form 55002011-01-11165
Total of all active and inactive participants2011-01-11165
Total participants2011-01-11165
2009: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2009 401k membership
Total participants, beginning-of-year2009-01-11171
Total number of active participants reported on line 7a of the Form 55002009-01-11171
Total of all active and inactive participants2009-01-11171
Total participants2009-01-11171
Total participants, beginning-of-year2009-01-01171
Total number of active participants reported on line 7a of the Form 55002009-01-01171
Total of all active and inactive participants2009-01-01171
Total participants2009-01-01171

Form 5500 Responses for BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT

2022: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01This submission is the final filingYes
2022-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 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 – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 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 – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 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 – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 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 – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 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 – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2014 form 5500 responses
2014-01-11Type of plan entitySingle employer plan
2014-01-11Submission has been amendedNo
2014-01-11This submission is the final filingNo
2014-01-11This return/report is a short plan year return/report (less than 12 months)No
2014-01-11Plan is a collectively bargained planNo
2014-01-11Plan funding arrangement – InsuranceYes
2014-01-11Plan funding arrangement – General assets of the sponsorYes
2014-01-11Plan benefit arrangement – InsuranceYes
2014-01-11Plan benefit arrangement – General assets of the sponsorYes
2013: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 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 – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2012 form 5500 responses
2012-01-11Type of plan entitySingle employer plan
2012-01-11Submission has been amendedNo
2012-01-11This submission is the final filingNo
2012-01-11This return/report is a short plan year return/report (less than 12 months)No
2012-01-11Plan is a collectively bargained planNo
2012-01-11Plan funding arrangement – InsuranceYes
2012-01-11Plan funding arrangement – General assets of the sponsorYes
2012-01-11Plan benefit arrangement – InsuranceYes
2012-01-11Plan benefit arrangement – General assets of the sponsorYes
2011: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2011 form 5500 responses
2011-01-11Type of plan entitySingle employer plan
2011-01-11Submission has been amendedNo
2011-01-11This submission is the final filingNo
2011-01-11This return/report is a short plan year return/report (less than 12 months)No
2011-01-11Plan is a collectively bargained planNo
2011-01-11Plan funding arrangement – InsuranceYes
2011-01-11Plan funding arrangement – General assets of the sponsorYes
2011-01-11Plan benefit arrangement – InsuranceYes
2011-01-11Plan benefit arrangement – General assets of the sponsorYes
2009: BAKER COMMODITIES, INC. GROUP TRAVEL ACCIDENT 2009 form 5500 responses
2009-01-11Type of plan entitySingle employer plan
2009-01-11Submission has been amendedYes
2009-01-11This submission is the final filingNo
2009-01-11This return/report is a short plan year return/report (less than 12 months)No
2009-01-11Plan is a collectively bargained planNo
2009-01-11Plan funding arrangement – InsuranceYes
2009-01-11Plan benefit arrangement – InsuranceYes
2009-01-11Plan benefit arrangement – General assets of the sponsorYes
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered0
Insurance policy start date2022-01-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $8
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees8
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered255
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $849
Total amount of fees paid to insurance companyUSD $48
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $5,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $849
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered213
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $800
Total amount of fees paid to insurance companyUSD $42
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
Other welfare benefits providedBTA
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees38
Insurance broker organization code?5
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered213
Insurance policy start date2019-01-11
Insurance policy end date2020-01-10
Total amount of commissions paid to insurance brokerUSD $825
Total amount of fees paid to insurance companyUSD $49
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
Other welfare benefits providedBTA
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees4
Insurance broker organization code?5
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered213
Insurance policy start date2018-01-11
Insurance policy end date2019-01-10
Total amount of commissions paid to insurance brokerUSD $775
Total amount of fees paid to insurance companyUSD $49
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
Other welfare benefits providedBTA
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees49
Insurance broker organization code?3
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered212
Insurance policy start date2017-01-11
Insurance policy end date2018-01-10
Total amount of commissions paid to insurance brokerUSD $762
Total amount of fees paid to insurance companyUSD $48
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
Other welfare benefits providedBTA
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees48
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameWELLS FARGO INS SERVICES USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered21
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $763
Total amount of fees paid to insurance companyUSD $55
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
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
Welfare Benefit Premiums Paid to CarrierUSD $5,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees55
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
Insurance broker nameWELLS FARGO INS SVCS USA INC
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered0
Insurance policy start date2014-01-11
Insurance policy end date2015-01-10
Total amount of commissions paid to insurance brokerUSD $70
Total amount of fees paid to insurance companyUSD $83
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
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
Amount paid for insurance broker fees83
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $70
Insurance broker nameWELLS FARGO INS SERVICES, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered0
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $17
Total amount of fees paid to insurance companyUSD $77
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
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
Amount paid for insurance broker fees77
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $17
Insurance broker nameWELLS FARGO INSURANCE SVCS USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered213
Insurance policy start date2012-01-11
Insurance policy end date2013-01-10
Total amount of commissions paid to insurance brokerUSD $1,639
Total amount of fees paid to insurance companyUSD $72
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33
Insurance broker organization code?3
Amount paid for insurance broker fees72
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered165
Insurance policy start date2011-01-11
Insurance policy end date2012-01-10
Total amount of commissions paid to insurance brokerUSD $604
Total amount of fees paid to insurance companyUSD $60
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $3,917
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number42227
Policy instance 1
Insurance contract or identification number42227
Number of Individuals Covered171
Insurance policy start date2010-01-11
Insurance policy end date2011-01-10
Total amount of commissions paid to insurance brokerUSD $559
Total amount of fees paid to insurance companyUSD $62
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $3,245
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48
Insurance broker organization code?3
Amount paid for insurance broker fees62
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATION FEES
Insurance broker nameAXA ASSISTANCE, USA

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