ROCKY MOUNTAIN SUPPLY, INC. has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022 : CO-OP 401(K) PLAN 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $434 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $132 |
| Total income from all sources (including contributions) | 2022-12-31 | $60,087 |
| Total loss/gain on sale of assets | 2022-12-31 | $0 |
| Total of all expenses incurred | 2022-12-31 | $141,937 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $119,749 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $446,927 |
| Value of total assets at end of year | 2022-12-31 | $3,159,196 |
| Value of total assets at beginning of year | 2022-12-31 | $3,240,744 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $22,188 |
| Total interest from all sources | 2022-12-31 | $1,116 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $86,600 |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-12-31 | $86,600 |
| Administrative expenses professional fees incurred | 2022-12-31 | $21,391 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $350,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $200,964 |
| Participant contributions at end of year | 2022-12-31 | $14,405 |
| Participant contributions at beginning of year | 2022-12-31 | $28,370 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-12-31 | $434 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-12-31 | $132 |
| Other income not declared elsewhere | 2022-12-31 | $-36,704 |
| Administrative expenses (other) incurred | 2022-12-31 | $797 |
| Total non interest bearing cash at end of year | 2022-12-31 | $15,652 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-81,850 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $3,158,762 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $3,240,612 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-12-31 | $2,663,726 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-12-31 | $2,693,626 |
| Interest on participant loans | 2022-12-31 | $1,116 |
| Value of interest in common/collective trusts at end of year | 2022-12-31 | $9,925 |
| Value of interest in common/collective trusts at beginning of year | 2022-12-31 | $27,712 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $86 |
| Asset value of US Government securities at end of year | 2022-12-31 | $142,578 |
| Asset value of US Government securities at beginning of year | 2022-12-31 | $201,375 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-12-31 | $-438,019 |
| Net investment gain or loss from common/collective trusts | 2022-12-31 | $167 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | Yes |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $245,963 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $119,749 |
| Asset. Corporate debt instrument preferred debt at end of year | 2022-12-31 | $109,780 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2022-12-31 | $100,142 |
| Asset. Corporate debt instrument debt (other) at end of year | 2022-12-31 | $203,044 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2022-12-31 | $189,519 |
| Did the plan have assets held for investment | 2022-12-31 | 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 | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | CLIFTONLARSONALLEN, LLP |
| Accountancy firm EIN | 2022-12-31 | 410746749 |
| Total unrealized appreciation/depreciation of assets | 2022-01-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-01-31 | $132 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-01-31 | $313 |
| Total income from all sources (including contributions) | 2022-01-31 | $545,530 |
| Total loss/gain on sale of assets | 2022-01-31 | $0 |
| Total of all expenses incurred | 2022-01-31 | $235,465 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-01-31 | $211,479 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-01-31 | $411,914 |
| Value of total assets at end of year | 2022-01-31 | $3,240,744 |
| Value of total assets at beginning of year | 2022-01-31 | $2,930,860 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-01-31 | $23,986 |
| Total interest from all sources | 2022-01-31 | $1,442 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-01-31 | $103,923 |
| Administrative expenses professional fees incurred | 2022-01-31 | $23,178 |
| Was this plan covered by a fidelity bond | 2022-01-31 | Yes |
| Value of fidelity bond cover | 2022-01-31 | $350,000 |
| If this is an individual account plan, was there a blackout period | 2022-01-31 | No |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2022-01-31 | $0 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-01-31 | No |
| Contributions received from participants | 2022-01-31 | $179,292 |
| Participant contributions at end of year | 2022-01-31 | $28,370 |
| Participant contributions at beginning of year | 2022-01-31 | $25,036 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-01-31 | $132 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-01-31 | $313 |
| Other income not declared elsewhere | 2022-01-31 | $-24,250 |
| Administrative expenses (other) incurred | 2022-01-31 | $808 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-01-31 | No |
| Value of net income/loss | 2022-01-31 | $310,065 |
| Value of net assets at end of year (total assets less liabilities) | 2022-01-31 | $3,240,612 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-01-31 | $2,930,547 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-01-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-01-31 | $2,693,626 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-01-31 | $2,365,404 |
| Interest on participant loans | 2022-01-31 | $1,442 |
| Value of interest in common/collective trusts at end of year | 2022-01-31 | $27,712 |
| Value of interest in common/collective trusts at beginning of year | 2022-01-31 | $53,716 |
| Asset value of US Government securities at end of year | 2022-01-31 | $201,375 |
| Asset value of US Government securities at beginning of year | 2022-01-31 | $235,196 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-01-31 | $52,488 |
| Net investment gain or loss from common/collective trusts | 2022-01-31 | $13 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-01-31 | Yes |
| Has the plan failed to provide any benefit when due under the plan | 2022-01-31 | No |
| Contributions received in cash from employer | 2022-01-31 | $232,622 |
| Income. Dividends from preferred stock | 2022-01-31 | $103,923 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-01-31 | $211,479 |
| Asset. Corporate debt instrument preferred debt at end of year | 2022-01-31 | $100,142 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2022-01-31 | $93,479 |
| Asset. Corporate debt instrument debt (other) at end of year | 2022-01-31 | $189,519 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2022-01-31 | $158,029 |
| Did the plan have assets held for investment | 2022-01-31 | 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 | 2022-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-01-31 | Unqualified |
| Accountancy firm name | 2022-01-31 | CLIFTONLARSONALLEN, LLP |
| Accountancy firm EIN | 2022-01-31 | 410746749 |
| 2021 : CO-OP 401(K) PLAN 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-01-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-01-31 | $313 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-01-31 | $0 |
| Total income from all sources (including contributions) | 2021-01-31 | $692,819 |
| Total loss/gain on sale of assets | 2021-01-31 | $0 |
| Total of all expenses incurred | 2021-01-31 | $225,995 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-01-31 | $208,161 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-01-31 | $331,235 |
| Value of total assets at end of year | 2021-01-31 | $2,930,860 |
| Value of total assets at beginning of year | 2021-01-31 | $2,463,723 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-01-31 | $17,834 |
| Total interest from all sources | 2021-01-31 | $1,537 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-01-31 | $69,961 |
| Administrative expenses professional fees incurred | 2021-01-31 | $17,094 |
| Was this plan covered by a fidelity bond | 2021-01-31 | Yes |
| Value of fidelity bond cover | 2021-01-31 | $350,000 |
| If this is an individual account plan, was there a blackout period | 2021-01-31 | No |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2021-01-31 | $0 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-01-31 | No |
| Contributions received from participants | 2021-01-31 | $140,229 |
| Participant contributions at end of year | 2021-01-31 | $25,036 |
| Participant contributions at beginning of year | 2021-01-31 | $14,741 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-01-31 | $313 |
| Other income not declared elsewhere | 2021-01-31 | $53,996 |
| Administrative expenses (other) incurred | 2021-01-31 | $740 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-01-31 | No |
| Value of net income/loss | 2021-01-31 | $466,824 |
| Value of net assets at end of year (total assets less liabilities) | 2021-01-31 | $2,930,547 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-01-31 | $2,463,723 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-01-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-01-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-01-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-01-31 | $2,365,404 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-01-31 | $2,448,982 |
| Interest on participant loans | 2021-01-31 | $1,537 |
| Value of interest in common/collective trusts at end of year | 2021-01-31 | $53,716 |
| Asset value of US Government securities at end of year | 2021-01-31 | $235,196 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2021-01-31 | $235,989 |
| Net investment gain or loss from common/collective trusts | 2021-01-31 | $101 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-01-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-01-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-01-31 | No |
| Contributions received in cash from employer | 2021-01-31 | $191,006 |
| Income. Dividends from preferred stock | 2021-01-31 | $69,961 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-01-31 | $208,161 |
| Asset. Corporate debt instrument preferred debt at end of year | 2021-01-31 | $93,479 |
| Asset. Corporate debt instrument debt (other) at end of year | 2021-01-31 | $158,029 |
| Did the plan have assets held for investment | 2021-01-31 | 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 | 2021-01-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-01-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-01-31 | Unqualified |
| Accountancy firm name | 2021-01-31 | CLIFTONLARSONALLEN, LLP |
| Accountancy firm EIN | 2021-01-31 | 410746749 |
| 2010 : CO-OP 401(K) PLAN 2010 401k financial data |
|---|
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2010-10-31 | $0 |
| MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MDA01360TR |
| Policy instance | 4 |
| Insurance contract or identification number | MDA01360TR | | Number of Individuals Covered | 149 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 062491 |
| Policy instance | 3 |
| Insurance contract or identification number | 062491 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | G-027795 |
| Policy instance | 2 |
| Insurance contract or identification number | G-027795 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | 1666920 |
| Policy instance | 1 |
| Insurance contract or identification number | 1666920 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
|
| MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MDA01360TR |
| Policy instance | 4 |
| Insurance contract or identification number | MDA01360TR | | Number of Individuals Covered | 138 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 062491 |
| Policy instance | 3 |
| Insurance contract or identification number | 062491 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
|
| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | G-027795 |
| Policy instance | 2 |
| Insurance contract or identification number | G-027795 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | 1666920 |
| Policy instance | 1 |
| Insurance contract or identification number | 1666920 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
|
| MONUMENTAL LIFE (National Association of Insurance Commissioners NAIC id number: 66281 ) |
| Policy contract number | MDA01360TR |
| Policy instance | 4 |
| Insurance contract or identification number | MDA01360TR | | Number of Individuals Covered | 132 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
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| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 062491 |
| Policy instance | 3 |
| Insurance contract or identification number | 062491 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
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| PACIFIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67466 ) |
| Policy contract number | G-027795 |
| Policy instance | 2 |
| Insurance contract or identification number | G-027795 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
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| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | 1666920 |
| Policy instance | 1 |
| Insurance contract or identification number | 1666920 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 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 |
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