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GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 401k Plan overview

Plan NameGOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN
Plan identification number 001

GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Plan covering Self-Employed individuals.
  • 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

GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC has sponsored the creation of one or more 401k plans.

Company Name:GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC
Employer identification number (EIN):475181001
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Additional information about GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 5821348

More information about GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01ROBERT WESTERGARD2020-10-14 ROBERT WESTERGARD2020-10-14
0012018-01-01VU TRAN2019-07-31
0012017-01-01VU TRAN2018-07-21
0012016-10-01SCOTT TONG2017-07-31
0012015-01-01

Plan Statistics for GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN

401k plan membership statisitcs for GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN

Measure Date Value
2022: GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01317
Total number of active participants reported on line 7a of the Form 55002022-01-01360
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0147
Total of all active and inactive participants2022-01-01407
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01407
Number of participants with account balances2022-01-01202
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01299
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 benefits2021-01-0140
Total of all active and inactive participants2021-01-01295
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01295
Number of participants with account balances2021-01-01178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01222
Total number of active participants reported on line 7a of the Form 55002020-01-01277
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0118
Total of all active and inactive participants2020-01-01295
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01295
Number of participants with account balances2020-01-01154
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2015: GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0111
Total number of active participants reported on line 7a of the Form 55002015-01-0112
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-013
Total of all active and inactive participants2015-01-0115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0115
Number of participants with account balances2015-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010

Financial Data on GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN

Measure Date Value
2022 : GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$4,199,568
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$696,956
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$684,867
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$6,478,694
Value of total assets at end of year2022-12-31$19,999,556
Value of total assets at beginning of year2022-12-31$16,496,944
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$12,089
Total interest from all sources2022-12-31$3,489
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$1,456,144
Participant contributions at end of year2022-12-31$116,949
Participant contributions at beginning of year2022-12-31$60,209
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$4,301,040
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$3,502,612
Value of net assets at end of year (total assets less liabilities)2022-12-31$19,999,556
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$16,496,944
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$8,977,062
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$5,493,333
Value of interest in pooled separate accounts at end of year2022-12-31$10,000,335
Value of interest in pooled separate accounts at beginning of year2022-12-31$10,291,125
Interest on participant loans2022-12-31$3,489
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$183,700
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$58,285
Net investment gain/loss from pooled separate accounts2022-12-31$-2,282,615
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31Yes
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$721,510
Employer contributions (assets) at end of year2022-12-31$721,510
Employer contributions (assets) at beginning of year2022-12-31$593,992
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$684,867
Contract administrator fees2022-12-31$12,089
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31WEAVER & TIDEWELL LLP
Accountancy firm EIN2022-12-31750786316
2021 : GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$3,956,667
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$248,254
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$246,533
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$2,913,794
Value of total assets at end of year2021-12-31$16,496,944
Value of total assets at beginning of year2021-12-31$12,788,531
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$1,721
Total interest from all sources2021-12-31$1,970
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,000,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$1,256,344
Participant contributions at end of year2021-12-31$60,209
Participant contributions at beginning of year2021-12-31$59,687
Participant contributions at beginning of year2021-12-31$15,667
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$1,062,791
Administrative expenses (other) incurred2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$3,708,413
Value of net assets at end of year (total assets less liabilities)2021-12-31$16,496,944
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$12,788,531
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$5,493,333
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$5,505,286
Value of interest in pooled separate accounts at end of year2021-12-31$10,291,125
Value of interest in pooled separate accounts at beginning of year2021-12-31$6,708,231
Interest on participant loans2021-12-31$1,970
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$58,285
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$54,799
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$0
Net investment gain/loss from pooled separate accounts2021-12-31$1,040,903
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$594,659
Employer contributions (assets) at end of year2021-12-31$593,992
Employer contributions (assets) at beginning of year2021-12-31$444,861
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$246,533
Contract administrator fees2021-12-31$1,721
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31HKG, LLP
Accountancy firm EIN2021-12-31954552788
2020 : GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$3,127,101
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$150,793
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$146,068
Value of total corrective distributions2020-12-31$2,100
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$2,081,866
Value of total assets at end of year2020-12-31$12,788,531
Value of total assets at beginning of year2020-12-31$9,812,223
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$2,625
Total interest from all sources2020-12-31$2,723
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$985,200
Participant contributions at end of year2020-12-31$59,687
Participant contributions at beginning of year2020-12-31$68,105
Participant contributions at end of year2020-12-31$15,667
Participant contributions at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$354,276
Assets. Loans (other than to participants) at beginning of year2020-12-31$0
Administrative expenses (other) incurred2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$2,976,308
Value of net assets at end of year (total assets less liabilities)2020-12-31$12,788,531
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$9,812,223
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$5,505,286
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$9,744,118
Value of interest in pooled separate accounts at end of year2020-12-31$6,708,231
Interest on participant loans2020-12-31$2,723
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$54,799
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$381,139
Net investment gain/loss from pooled separate accounts2020-12-31$661,373
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$742,390
Employer contributions (assets) at end of year2020-12-31$444,861
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$146,068
Contract administrator fees2020-12-31$2,625
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31Yes
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31SHEA LABAGH DOBBERSTEIN CPAS
Accountancy firm EIN2020-12-31942290202
2015 : GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$4,173
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$100,482
Expenses. Total of all expenses incurred2015-12-31$16
Total plan assets at end of year2015-12-31$3,012,585
Total plan assets at beginning of year2015-12-31$2,907,946
Value of fidelity bond covering the plan2015-12-31$200,000
Total contributions received or receivable from participants2015-12-31$102,900
Expenses. Other expenses not covered elsewhere2015-12-31$0
Contributions received from other sources (not participants or employers)2015-12-31$33,828
Other income received2015-12-31$-77,010
Noncash contributions received2015-12-31$0
Net income (gross income less expenses)2015-12-31$100,466
Net plan assets at end of year (total assets less liabilities)2015-12-31$3,008,412
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$2,907,946
Assets. Value of participant loans2015-12-31$46,235
Total contributions received or receivable from employer(s)2015-12-31$40,764
Value of certain deemed distributions of participant loans2015-12-31$0
Value of corrective distributions2015-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$16

Form 5500 Responses for GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN

2022: GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2015: GOLDEN STATE DERMATOLOGY MANAGEMENT, LLC 401(K) 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 – TrustYes
2015-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG39871
Policy instance 1
Insurance contract or identification numberG39871
Number of Individuals Covered193
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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?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
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG39871
Policy instance 1
Insurance contract or identification numberG39871
Number of Individuals Covered177
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )
Policy contract numberG39871
Policy instance 1
Insurance contract or identification numberG39871
Number of Individuals Covered149
Insurance policy start date2020-09-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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