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DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan NameDB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST
Plan identification number 002

DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • 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.

401k Sponsoring company profile

DB GRANT ASSOCIATES INC. has sponsored the creation of one or more 401k plans.

Company Name:DB GRANT ASSOCIATES INC.
Employer identification number (EIN):133961389
NAIC Classification:561300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022015-01-01RICK FILIPPELLI
0022014-01-01RICK FILIPPELLI
0022013-01-01RICK FILIPPELLI
0022012-01-01MARY GUERNIER
0022011-01-01MARY GUERNIER2012-10-15
0022010-01-01DB GRANT ASSOCIATES INC2011-07-13

Plan Statistics for DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2015: DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-01430
Total number of active participants reported on line 7a of the Form 55002015-01-01225
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-01160
Total of all active and inactive participants2015-01-01385
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01385
Number of participants with account balances2015-01-01336
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-01372
Total number of active participants reported on line 7a of the Form 55002014-01-01291
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-01113
Total of all active and inactive participants2014-01-01404
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01404
Number of participants with account balances2014-01-01325
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-01269
Total number of active participants reported on line 7a of the Form 55002013-01-01285
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0166
Total of all active and inactive participants2013-01-01351
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01351
Number of participants with account balances2013-01-01244
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-01171
Total number of active participants reported on line 7a of the Form 55002012-01-01195
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0141
Total of all active and inactive participants2012-01-01236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01236
Number of participants with account balances2012-01-01183
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010

Financial Data on DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2015 : DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$942,087
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$1,077,978
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$1,052,693
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,018,446
Value of total assets at end of year2015-12-31$4,833,008
Value of total assets at beginning of year2015-12-31$4,968,899
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$25,285
Total interest from all sources2015-12-31$8,619
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$9,042
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$481,907
Participant contributions at end of year2015-12-31$251,630
Participant contributions at beginning of year2015-12-31$186,567
Participant contributions at end of year2015-12-31$24,450
Participant contributions at beginning of year2015-12-31$15,493
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$16,962
Other income not declared elsewhere2015-12-31$4,260
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-135,891
Value of net assets at end of year (total assets less liabilities)2015-12-31$4,833,008
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$4,968,899
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$3,742,437
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$4,204,039
Interest on participant loans2015-12-31$8,253
Interest earned on other investments2015-12-31$366
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$294,914
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-89,238
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$519,577
Employer contributions (assets) at end of year2015-12-31$519,577
Employer contributions (assets) at beginning of year2015-12-31$562,800
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$1,052,693
Contract administrator fees2015-12-31$16,243
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31SOBEL & CO., LLC
Accountancy firm EIN2015-12-31221430039
2014 : DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$1,230,862
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$342,973
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$342,973
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$1,084,521
Value of total assets at end of year2014-12-31$4,968,899
Value of total assets at beginning of year2014-12-31$4,081,010
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$0
Total interest from all sources2014-12-31$7,132
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
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$513,273
Participant contributions at end of year2014-12-31$186,567
Participant contributions at beginning of year2014-12-31$158,821
Participant contributions at end of year2014-12-31$15,493
Participant contributions at beginning of year2014-12-31$2,224
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$6,173
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$887,889
Value of net assets at end of year (total assets less liabilities)2014-12-31$4,968,899
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$4,081,010
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 registered invesment companies (eg mutual funds) at end of year2014-12-31$4,204,039
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$3,233,305
Interest on participant loans2014-12-31$7,132
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$139,209
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$565,075
Employer contributions (assets) at end of year2014-12-31$562,800
Employer contributions (assets) at beginning of year2014-12-31$686,660
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$342,973
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 name2014-12-31SOBEL & CO., LLC
Accountancy firm EIN2014-12-31221430039
2013 : DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$1,556,622
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$183,899
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$178,798
Expenses. Certain deemed distributions of participant loans2013-12-31$5,101
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,159,934
Value of total assets at end of year2013-12-31$4,081,010
Value of total assets at beginning of year2013-12-31$2,708,287
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$0
Total interest from all sources2013-12-31$6,451
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
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$400,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$466,676
Participant contributions at end of year2013-12-31$158,821
Participant contributions at beginning of year2013-12-31$133,302
Participant contributions at end of year2013-12-31$2,224
Participant contributions at beginning of year2013-12-31$67,830
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$7,376
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$5,656
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$1,372,723
Value of net assets at end of year (total assets less liabilities)2013-12-31$4,081,010
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$2,708,287
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 registered invesment companies (eg mutual funds) at end of year2013-12-31$3,233,305
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$1,952,951
Interest on participant loans2013-12-31$6,451
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$390,237
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 contributions2013-12-31Yes
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$685,882
Employer contributions (assets) at end of year2013-12-31$686,660
Employer contributions (assets) at beginning of year2013-12-31$548,548
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$178,798
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 name2013-12-31SOBEL & CO., LLC
Accountancy firm EIN2013-12-31221430039
2012 : DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$1,157,825
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$189,835
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$181,065
Expenses. Certain deemed distributions of participant loans2012-12-31$8,770
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$981,118
Value of total assets at end of year2012-12-31$2,708,287
Value of total assets at beginning of year2012-12-31$1,740,297
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$0
Total interest from all sources2012-12-31$4,168
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$400,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$419,535
Participant contributions at end of year2012-12-31$133,302
Participant contributions at beginning of year2012-12-31$29,418
Participant contributions at end of year2012-12-31$67,830
Participant contributions at beginning of year2012-12-31$46,833
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$13,035
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$5,656
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$1,170
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$967,990
Value of net assets at end of year (total assets less liabilities)2012-12-31$2,708,287
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$1,740,297
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$1,952,951
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$1,301,822
Interest on participant loans2012-12-31$4,168
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$172,539
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31Yes
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$548,548
Employer contributions (assets) at end of year2012-12-31$548,548
Employer contributions (assets) at beginning of year2012-12-31$361,054
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$181,065
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31SOBEL & CO., LLC
Accountancy firm EIN2012-12-31221430039

Form 5500 Responses for DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST

2015: DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 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 – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 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 – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: DB GRANT ASSOCIATES INC. 401(K) PROFIT SHARING PLAN AND TRUST 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-HS1X
Policy instance 1
Insurance contract or identification numberGAP-CP-HS1X
Number of Individuals Covered22
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $66
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $66
Insurance broker organization code?4
Insurance broker nameL. M. KOHN & COMPANY

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