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CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 401k Plan overview

Plan NameCAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN
Plan identification number 010

CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • 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.
  • 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

CAPEWAY ROOFING SYSTEMS, INC. has sponsored the creation of one or more 401k plans.

Company Name:CAPEWAY ROOFING SYSTEMS, INC.
Employer identification number (EIN):042899319
NAIC Classification:238100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0102015-01-01JOE CALHETA JOE CALHETA2016-10-04
0102014-01-01JOSE CALHETA JOSE CALHETA2015-08-27
0102013-01-01JOE CALHETA JOE CALHETA2014-10-07
0102012-01-01JOE CALHETA2013-07-23 JOE CALHETA2013-07-23
0102011-01-01JOE CALHETA2012-07-03 JOE CALHETA2012-07-03
0102010-01-01JOSE CALHETA JOSE CALHETA2012-05-31
0102009-01-01JOE CALHETA JOE CALHETA2011-08-24

Plan Statistics for CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN

401k plan membership statisitcs for CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN

Measure Date Value
2015: CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01144
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-010
Number of participants with account balances2015-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01139
Total number of active participants reported on line 7a of the Form 55002014-01-01118
Number of other retired or separated participants entitled to future benefits2014-01-0123
Total of all active and inactive participants2014-01-01141
Total participants2014-01-01141
Number of participants with account balances2014-01-01140
2013: CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01123
Total number of active participants reported on line 7a of the Form 55002013-01-01114
Number of other retired or separated participants entitled to future benefits2013-01-0121
Total of all active and inactive participants2013-01-01135
Total participants2013-01-01135
Number of participants with account balances2013-01-01135
2010: CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01111
Total number of active participants reported on line 7a of the Form 55002010-01-01105
Number of other retired or separated participants entitled to future benefits2010-01-0116
Total of all active and inactive participants2010-01-01121
Total participants2010-01-01121
Number of participants with account balances2010-01-01119
2009: CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01102
Total number of active participants reported on line 7a of the Form 55002009-01-0191
Number of other retired or separated participants entitled to future benefits2009-01-0114
Total of all active and inactive participants2009-01-01105
Total participants2009-01-01105
Number of participants with account balances2009-01-01104

Financial Data on CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN

Measure Date Value
2015 : CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2015 401k financial data
Total transfer of assets from this plan2015-12-23$3,382,201
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-23$13,000
Total income from all sources (including contributions)2015-12-23$387,242
Total of all expenses incurred2015-12-23$718,105
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-23$690,002
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-23$416,017
Value of total assets at end of year2015-12-23$0
Value of total assets at beginning of year2015-12-23$3,726,064
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-23$28,103
Total interest from all sources2015-12-23$22,367
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-23Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2015-12-23$0
Administrative expenses professional fees incurred2015-12-23$2,901
Was this plan covered by a fidelity bond2015-12-23Yes
Value of fidelity bond cover2015-12-23$1,000,000
If this is an individual account plan, was there a blackout period2015-12-23Yes
Were there any nonexempt tranactions with any party-in-interest2015-12-23No
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-23$13,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-23No
Value of net income/loss2015-12-23$-330,863
Value of net assets at end of year (total assets less liabilities)2015-12-23$0
Value of net assets at beginning of year (total assets less liabilities)2015-12-23$3,713,064
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-23No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-23No
Were any leases to which the plan was party in default or uncollectible2015-12-23No
Value of interest in pooled separate accounts at end of year2015-12-23$0
Value of interest in pooled separate accounts at beginning of year2015-12-23$1,337,141
Interest earned on other investments2015-12-23$22,367
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-23$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-23$2,358,613
Net investment gain/loss from pooled separate accounts2015-12-23$-51,142
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-23No
Was there a failure to transmit to the plan any participant contributions2015-12-23No
Has the plan failed to provide any benefit when due under the plan2015-12-23No
Contributions received in cash from employer2015-12-23$416,017
Employer contributions (assets) at end of year2015-12-23$0
Employer contributions (assets) at beginning of year2015-12-23$30,310
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-23$690,002
Contract administrator fees2015-12-23$25,202
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-23Yes
Did the plan have assets held for investment2015-12-23No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-23No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-23Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-23Yes
Opinion of an independent qualified public accountant for this plan2015-12-23Disclaimer
Accountancy firm name2015-12-23YKSM, LTD.
Accountancy firm EIN2015-12-23050514919
2014 : CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$13,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$14,000
Total income from all sources (including contributions)2014-12-31$655,170
Total of all expenses incurred2014-12-31$312,469
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$279,421
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$543,214
Value of total assets at end of year2014-12-31$3,726,064
Value of total assets at beginning of year2014-12-31$3,384,363
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$33,048
Total interest from all sources2014-12-31$33,427
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$0
Administrative expenses professional fees incurred2014-12-31$13,895
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$1,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$13,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$14,000
Administrative expenses (other) incurred2014-12-31$1,400
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$342,701
Value of net assets at end of year (total assets less liabilities)2014-12-31$3,713,064
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$3,370,363
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in pooled separate accounts at end of year2014-12-31$1,337,141
Value of interest in pooled separate accounts at beginning of year2014-12-31$1,246,663
Interest earned on other investments2014-12-31$33,427
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$2,358,613
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$2,094,033
Net investment gain/loss from pooled separate accounts2014-12-31$78,529
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$543,214
Employer contributions (assets) at end of year2014-12-31$30,310
Employer contributions (assets) at beginning of year2014-12-31$43,667
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$279,421
Contract administrator fees2014-12-31$17,753
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31YKSM, LTD.
Accountancy firm EIN2014-12-31050514919
2013 : CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$14,000
Total income from all sources (including contributions)2013-12-31$719,991
Total of all expenses incurred2013-12-31$136,016
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$105,188
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$538,164
Value of total assets at end of year2013-12-31$3,384,363
Value of total assets at beginning of year2013-12-31$2,786,388
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$30,828
Total interest from all sources2013-12-31$36,701
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$14,000
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$340,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$14,000
Administrative expenses (other) incurred2013-12-31$800
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$583,975
Value of net assets at end of year (total assets less liabilities)2013-12-31$3,370,363
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$2,786,388
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in pooled separate accounts at end of year2013-12-31$1,246,663
Value of interest in pooled separate accounts at beginning of year2013-12-31$1,020,456
Interest earned on other investments2013-12-31$36,701
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$2,094,033
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$1,741,657
Net investment gain/loss from pooled separate accounts2013-12-31$145,126
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$538,164
Employer contributions (assets) at end of year2013-12-31$43,667
Employer contributions (assets) at beginning of year2013-12-31$24,275
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$105,188
Contract administrator fees2013-12-31$16,028
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31YKSM, LTD.
Accountancy firm EIN2013-12-31050514919
2010 : CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2010 401k financial data
Total income from all sources2010-12-31$435,378
Expenses. Total of all expenses incurred2010-12-31$174,266
Benefits paid (including direct rollovers)2010-12-31$174,266
Total plan assets at end of year2010-12-31$2,147,729
Total plan assets at beginning of year2010-12-31$1,886,617
Value of fidelity bond covering the plan2010-12-31$277,000
Other income received2010-12-31$88,457
Net income (gross income less expenses)2010-12-31$261,112
Net plan assets at end of year (total assets less liabilities)2010-12-31$2,147,729
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,886,617
Total contributions received or receivable from employer(s)2010-12-31$346,921

Form 5500 Responses for CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN

2015: CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT 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 filingYes
2015-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2010: CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: CAPEWAY ROOFING SYSTEMS, INC. RETIREMENT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP44-8398
Policy instance 1
Insurance contract or identification numberGAP44-8398
Number of Individuals Covered0
Insurance policy start date2015-01-01
Insurance policy end date2015-03-16
Total amount of commissions paid to insurance brokerUSD $1,687
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,687
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerFEES PAID ON THE BASIS OF AGGERATED VALUE OF CONTRACT PLACED & RETAINED
Insurance broker organization code?7
Insurance broker nameNFP ADVISOR SERVICES, LLC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP42-8397
Policy instance 2
Insurance contract or identification numberGAP42-8397
Number of Individuals Covered0
Insurance policy start date2015-01-01
Insurance policy end date2015-03-16
Total amount of commissions paid to insurance brokerUSD $3,421
Total amount of fees paid to insurance companyUSD $1,965
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,421
Amount paid for insurance broker fees1965
Additional information about fees paid to insurance brokerFEES PAID ON BASIS OF AGGREATED VALUE OF CONTRACT PLACED & RETAINED
Insurance broker organization code?7
Insurance broker nameNFP ADVISOR SERVICES, LLC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-GW3E
Policy instance 3
Insurance contract or identification numberGAP-CP-GW3E
Number of Individuals Covered0
Insurance policy start date2015-03-16
Insurance policy end date2015-12-23
Total amount of commissions paid to insurance brokerUSD $2,382
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,382
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerFEES PAID ON BASIS OF AGGREATED VALUE OF CONTRACT PLACED & RETAINED
Insurance broker organization code?7
Insurance broker nameNFP ADVISOR SERVICES, LLC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP44-8398
Policy instance 1
Insurance contract or identification numberGAP44-8398
Number of Individuals Covered140
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $8,778
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,001
Additional information about fees paid to insurance brokerFEES PAID ON THE BASIS OF AGGERATED VALUE OF CONTRACT PLACED & RETAINED
Insurance broker organization code?5
Insurance broker nameNFP ADVISOR SERVICES, LLC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP42-8397
Policy instance 2
Insurance contract or identification numberGAP42-8397
Number of Individuals Covered140
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $17,158
Total amount of fees paid to insurance companyUSD $9,661
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,578
Amount paid for insurance broker fees9661
Additional information about fees paid to insurance brokerFEES PAID ON BASIS OF AGGREATED VALUE OF CONTRACT PLACED & RETAINED
Insurance broker organization code?5
Insurance broker nameNFP ADVISOR SERVICES, LLC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP44-8398
Policy instance 1
Insurance contract or identification numberGAP44-8398
Number of Individuals Covered135
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $7,746
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,746
Additional information about fees paid to insurance brokerFEES PAID OON THE BASIS OF AGGERATED VALUE OF CONTRACT PLACED & RETAINED
Insurance broker organization code?5
Insurance broker nameFINANCIAL TELESIS INC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP42-8397
Policy instance 2
Insurance contract or identification numberGAP42-8397
Number of Individuals Covered135
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $14,645
Total amount of fees paid to insurance companyUSD $8,208
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,645
Amount paid for insurance broker fees8208
Additional information about fees paid to insurance brokerFEEL PAID ON THE BASIS OF AGGERATED VALUE OF CONTRACT PLACED & RETAINED
Insurance broker organization code?5
Insurance broker nameFINANCIAL THELESIS INC
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP44-8398
Policy instance 1
Insurance contract or identification numberGAP44-8398
Number of Individuals Covered119
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $6,177
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP42-8397
Policy instance 2
Insurance contract or identification numberGAP42-8397
Number of Individuals Covered119
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $8,373
Total amount of fees paid to insurance companyUSD $5,054
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Other information about contractGUARANTEED INVESTMENT

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