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403(B) THRIFT PLAN OF PACIFIC CLINICS 401k Plan overview

Plan Name403(B) THRIFT PLAN OF PACIFIC CLINICS
Plan identification number 008

403(B) THRIFT PLAN OF PACIFIC CLINICS Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

UPLIFT FAMILY SERVICES D/B/A PACIFIC CLINICS has sponsored the creation of one or more 401k plans.

Company Name:UPLIFT FAMILY SERVICES D/B/A PACIFIC CLINICS
Employer identification number (EIN):942295953
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 403(B) THRIFT PLAN OF PACIFIC CLINICS

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0082022-07-01
0082021-07-01
0082021-07-01

Plan Statistics for 403(B) THRIFT PLAN OF PACIFIC CLINICS

401k plan membership statisitcs for 403(B) THRIFT PLAN OF PACIFIC CLINICS

Measure Date Value
2022: 403(B) THRIFT PLAN OF PACIFIC CLINICS 2022 401k membership
Total participants, beginning-of-year2022-07-011,436
Total number of active participants reported on line 7a of the Form 55002022-07-010
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-07-010
Total participants2022-07-010
Number of participants with account balances2022-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-07-0183
2021: 403(B) THRIFT PLAN OF PACIFIC CLINICS 2021 401k membership
Total participants, beginning-of-year2021-07-011,523
Total number of active participants reported on line 7a of the Form 55002021-07-01848
Number of retired or separated participants receiving benefits2021-07-0115
Number of other retired or separated participants entitled to future benefits2021-07-01569
Total of all active and inactive participants2021-07-011,432
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-07-010
Total participants2021-07-011,432
Number of participants with account balances2021-07-011,398
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-07-01207

Financial Data on 403(B) THRIFT PLAN OF PACIFIC CLINICS

Measure Date Value
2023 : 403(B) THRIFT PLAN OF PACIFIC CLINICS 2023 401k financial data
Unrealized appreciation/depreciation of real estate assets2023-03-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2023-03-31$0
Total unrealized appreciation/depreciation of assets2023-03-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-03-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-03-31$0
Expenses. Interest paid2023-03-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022023-03-31$0
Total income from all sources (including contributions)2023-03-31$3,986,669
Total loss/gain on sale of assets2023-03-31$0
Total of all expenses incurred2023-03-31$53,042,529
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-03-31$52,475,131
Expenses. Certain deemed distributions of participant loans2023-03-31$458,761
Value of total corrective distributions2023-03-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-03-31$1,510,923
Value of total assets at end of year2023-03-31$0
Value of total assets at beginning of year2023-03-31$49,055,860
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-03-31$108,637
Total income from rents2023-03-31$0
Total interest from all sources2023-03-31$109,892
Total dividends received (eg from common stock, registered investment company shares)2023-03-31$809,332
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-03-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2023-03-31$0
Total dividends received from registered investment company shares (eg mutual funds)2023-03-31$809,332
Assets. Real estate other than employer real property at end of year2023-03-31$0
Assets. Real estate other than employer real property at beginning of year2023-03-31$0
Administrative expenses professional fees incurred2023-03-31$16,800
Assets. Corporate prefeered stocks other than exployer securities at end of year2023-03-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2023-03-31$0
Was this plan covered by a fidelity bond2023-03-31Yes
Value of fidelity bond cover2023-03-31$2,000,000
If this is an individual account plan, was there a blackout period2023-03-31No
Were there any nonexempt tranactions with any party-in-interest2023-03-31No
Contributions received from participants2023-03-31$1,496,699
Participant contributions at end of year2023-03-31$0
Participant contributions at beginning of year2023-03-31$181,383
Participant contributions at end of year2023-03-31$0
Participant contributions at beginning of year2023-03-31$414,874
Assets. Other investments not covered elsewhere at end of year2023-03-31$0
Assets. Other investments not covered elsewhere at beginning of year2023-03-31$0
Income. Received or receivable in cash from other sources (including rollovers)2023-03-31$177,636
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2023-03-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-03-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-03-31$0
Assets. Loans (other than to participants) at end of year2023-03-31$0
Assets. Loans (other than to participants) at beginning of year2023-03-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-03-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-03-31$0
Other income not declared elsewhere2023-03-31$0
Administrative expenses (other) incurred2023-03-31$0
Liabilities. Value of operating payables at end of year2023-03-31$0
Liabilities. Value of operating payables at beginning of year2023-03-31$0
Total non interest bearing cash at end of year2023-03-31$0
Total non interest bearing cash at beginning of year2023-03-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-03-31No
Income. Non cash contributions2023-03-31$0
Value of net income/loss2023-03-31$-49,055,860
Value of net assets at end of year (total assets less liabilities)2023-03-31$0
Value of net assets at beginning of year (total assets less liabilities)2023-03-31$49,055,860
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-03-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-03-31No
Were any leases to which the plan was party in default or uncollectible2023-03-31No
Assets. partnership/joint venture interests at end of year2023-03-31$0
Assets. partnership/joint venture interests at beginning of year2023-03-31$0
Investment advisory and management fees2023-03-31$35,857
Value of interest in registered invesment companies (eg mutual funds) at end of year2023-03-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-03-31$33,841,926
Value of interest in pooled separate accounts at end of year2023-03-31$0
Value of interest in pooled separate accounts at beginning of year2023-03-31$0
Interest on participant loans2023-03-31$9,542
Income. Interest from loans (other than to participants)2023-03-31$0
Interest earned on other investments2023-03-31$100,350
Income. Interest from US Government securities2023-03-31$0
Income. Interest from corporate debt instruments2023-03-31$0
Value of interest in master investment trust accounts at end of year2023-03-31$0
Value of interest in master investment trust accounts at beginning of year2023-03-31$0
Value of interest in common/collective trusts at end of year2023-03-31$0
Value of interest in common/collective trusts at beginning of year2023-03-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2023-03-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2023-03-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2023-03-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2023-03-31$0
Assets. Value of investments in 103.12 investment entities at end of year2023-03-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2023-03-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2023-03-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2023-03-31$12,359,909
Expenses. Payments to insurance carriers foe the provision of benefits2023-03-31$0
Asset value of US Government securities at end of year2023-03-31$0
Asset value of US Government securities at beginning of year2023-03-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2023-03-31$1,556,522
Net investment gain/loss from pooled separate accounts2023-03-31$0
Net investment gain or loss from common/collective trusts2023-03-31$0
Net gain/loss from 103.12 investment entities2023-03-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-03-31No
Was there a failure to transmit to the plan any participant contributions2023-03-31No
Has the plan failed to provide any benefit when due under the plan2023-03-31No
Assets. Invements in employer securities at end of year2023-03-31$0
Assets. Invements in employer securities at beginning of year2023-03-31$0
Assets. Value of employer real property at end of year2023-03-31$0
Assets. Value of employer real property at beginning of year2023-03-31$0
Contributions received in cash from employer2023-03-31$-163,412
Employer contributions (assets) at end of year2023-03-31$0
Employer contributions (assets) at beginning of year2023-03-31$2,257,768
Income. Dividends from preferred stock2023-03-31$0
Income. Dividends from common stock2023-03-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-03-31$52,475,131
Asset. Corporate debt instrument preferred debt at end of year2023-03-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2023-03-31$0
Asset. Corporate debt instrument debt (other) at end of year2023-03-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2023-03-31$0
Contract administrator fees2023-03-31$55,980
Assets. Corporate common stocks other than exployer securities at end of year2023-03-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2023-03-31$0
Liabilities. Value of benefit claims payable at end of year2023-03-31$0
Liabilities. Value of benefit claims payable at beginning of year2023-03-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2023-03-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2023-03-31$0
Did the plan have assets held for investment2023-03-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-03-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-03-31Yes
Aggregate proceeds on sale of assets2023-03-31$0
Aggregate carrying amount (costs) on sale of assets2023-03-31$0
Liabilities. Value of acquisition indebtedness at end of year2023-03-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2023-03-31$0
Opinion of an independent qualified public accountant for this plan2023-03-31Unqualified
Accountancy firm name2023-03-31LEE CPA AUDIT GROUP
Accountancy firm EIN2023-03-31814637885
2022 : 403(B) THRIFT PLAN OF PACIFIC CLINICS 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets2022-06-30$0
Unrealized appreciation/depreciation of other (non real estate) assets2022-06-30$0
Total unrealized appreciation/depreciation of assets2022-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$0
Expenses. Interest paid2022-06-30$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022022-06-30$0
Total income from all sources (including contributions)2022-06-30$-564,269
Total loss/gain on sale of assets2022-06-30$0
Total of all expenses incurred2022-06-30$4,474,857
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$4,360,604
Expenses. Certain deemed distributions of participant loans2022-06-30$0
Value of total corrective distributions2022-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$6,124,446
Value of total assets at end of year2022-06-30$49,055,860
Value of total assets at beginning of year2022-06-30$54,094,986
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$114,253
Total income from rents2022-06-30$0
Total interest from all sources2022-06-30$180,814
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$1,774,576
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2022-06-30$1,774,576
Assets. Real estate other than employer real property at end of year2022-06-30$0
Assets. Real estate other than employer real property at beginning of year2022-06-30$0
Administrative expenses professional fees incurred2022-06-30$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2022-06-30$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2022-06-30$0
Was this plan covered by a fidelity bond2022-06-30Yes
Value of fidelity bond cover2022-06-30$2,000,000
If this is an individual account plan, was there a blackout period2022-06-30No
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$3,641,711
Participant contributions at end of year2022-06-30$181,383
Participant contributions at beginning of year2022-06-30$434,631
Participant contributions at end of year2022-06-30$414,874
Participant contributions at beginning of year2022-06-30$147,676
Assets. Other investments not covered elsewhere at end of year2022-06-30$0
Assets. Other investments not covered elsewhere at beginning of year2022-06-30$0
Income. Received or receivable in cash from other sources (including rollovers)2022-06-30$224,647
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-06-30$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-06-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-06-30$0
Assets. Loans (other than to participants) at end of year2022-06-30$0
Assets. Loans (other than to participants) at beginning of year2022-06-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-06-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-06-30$0
Other income not declared elsewhere2022-06-30$666
Administrative expenses (other) incurred2022-06-30$39,000
Liabilities. Value of operating payables at end of year2022-06-30$0
Liabilities. Value of operating payables at beginning of year2022-06-30$0
Total non interest bearing cash at end of year2022-06-30$0
Total non interest bearing cash at beginning of year2022-06-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Income. Non cash contributions2022-06-30$0
Value of net income/loss2022-06-30$-5,039,126
Value of net assets at end of year (total assets less liabilities)2022-06-30$49,055,860
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$54,094,986
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Assets. partnership/joint venture interests at end of year2022-06-30$0
Assets. partnership/joint venture interests at beginning of year2022-06-30$0
Investment advisory and management fees2022-06-30$18,451
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-06-30$33,841,926
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-06-30$39,064,859
Value of interest in pooled separate accounts at end of year2022-06-30$0
Value of interest in pooled separate accounts at beginning of year2022-06-30$0
Interest on participant loans2022-06-30$15,665
Income. Interest from loans (other than to participants)2022-06-30$0
Interest earned on other investments2022-06-30$165,149
Income. Interest from US Government securities2022-06-30$0
Income. Interest from corporate debt instruments2022-06-30$0
Value of interest in master investment trust accounts at end of year2022-06-30$0
Value of interest in master investment trust accounts at beginning of year2022-06-30$0
Value of interest in common/collective trusts at end of year2022-06-30$0
Value of interest in common/collective trusts at beginning of year2022-06-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-06-30$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-06-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-06-30$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-06-30$0
Assets. Value of investments in 103.12 investment entities at end of year2022-06-30$0
Assets. Value of investments in 103.12 investment entities at beginning of year2022-06-30$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-06-30$12,359,909
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-06-30$12,147,820
Expenses. Payments to insurance carriers foe the provision of benefits2022-06-30$0
Asset value of US Government securities at end of year2022-06-30$0
Asset value of US Government securities at beginning of year2022-06-30$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-06-30$-8,644,771
Net investment gain/loss from pooled separate accounts2022-06-30$0
Net investment gain or loss from common/collective trusts2022-06-30$0
Net gain/loss from 103.12 investment entities2022-06-30$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30No
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Assets. Invements in employer securities at end of year2022-06-30$0
Assets. Invements in employer securities at beginning of year2022-06-30$0
Assets. Value of employer real property at end of year2022-06-30$0
Assets. Value of employer real property at beginning of year2022-06-30$0
Contributions received in cash from employer2022-06-30$2,258,088
Employer contributions (assets) at end of year2022-06-30$2,257,768
Employer contributions (assets) at beginning of year2022-06-30$2,300,000
Income. Dividends from preferred stock2022-06-30$0
Income. Dividends from common stock2022-06-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$4,360,604
Asset. Corporate debt instrument preferred debt at end of year2022-06-30$0
Asset. Corporate debt instrument preferred debt at beginning of year2022-06-30$0
Asset. Corporate debt instrument debt (other) at end of year2022-06-30$0
Asset. Corporate debt instrument debt (other) at beginning of year2022-06-30$0
Contract administrator fees2022-06-30$56,802
Assets. Corporate common stocks other than exployer securities at end of year2022-06-30$0
Assets. Corporate common stocks other than exployer securities at beginning of year2022-06-30$0
Liabilities. Value of benefit claims payable at end of year2022-06-30$0
Liabilities. Value of benefit claims payable at beginning of year2022-06-30$0
Assets. Value of buildings and other operty used in plan operation at end of year2022-06-30$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2022-06-30$0
Did the plan have assets held for investment2022-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30No
Aggregate proceeds on sale of assets2022-06-30$0
Aggregate carrying amount (costs) on sale of assets2022-06-30$0
Liabilities. Value of acquisition indebtedness at end of year2022-06-30$0
Liabilities. Value of acquisition indebtedness at beginning of year2022-06-30$0
Opinion of an independent qualified public accountant for this plan2022-06-30Unqualified
Accountancy firm name2022-06-30RSM US LLP
Accountancy firm EIN2022-06-30420714325

Form 5500 Responses for 403(B) THRIFT PLAN OF PACIFIC CLINICS

2022: 403(B) THRIFT PLAN OF PACIFIC CLINICS 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Submission has been amendedNo
2022-07-01This submission is the final filingYes
2022-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2022-07-01Plan is a collectively bargained planNo
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – TrustYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement - TrustYes
2021: 403(B) THRIFT PLAN OF PACIFIC CLINICS 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number140026-01
Policy instance 1
Insurance contract or identification number140026-01
Number of Individuals Covered0
Insurance policy start date2022-07-01
Insurance policy end date2023-03-31
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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number140026-01
Policy instance 1
Insurance contract or identification number140026-01
Number of Individuals Covered617
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
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

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