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LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 401k Plan overview

Plan NameLAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN
Plan identification number 001

LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) 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.
  • 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.

401k Sponsoring company profile

LAKESIDE COMPREHENSIVE REHABILITATION INC has sponsored the creation of one or more 401k plans.

Company Name:LAKESIDE COMPREHENSIVE REHABILITATION INC
Employer identification number (EIN):300167858
NAIC Classification:621340
NAIC Description:Offices of Physical, Occupational and Speech Therapists, and Audiologists

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01DEBORAH WINDELL
0012016-01-01DEBORAH WINDELL
0012015-01-01DEBORAH WINDELL
0012014-01-01DEBORAH WINDELL
0012013-01-01DEBORAH WINDELL
0012012-01-01DEBORAH WINDELL
0012011-01-01DEBORAH WINDELL

Plan Statistics for LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN

401k plan membership statisitcs for LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN

Measure Date Value
2022: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0124
Total number of active participants reported on line 7a of the Form 55002022-01-0124
Number of retired or separated participants receiving benefits2022-01-014
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-0128
Number of participants with account balances2022-01-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0119
Total number of active participants reported on line 7a of the Form 55002021-01-0119
Number of retired or separated participants receiving benefits2021-01-015
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0124
Number of participants with account balances2021-01-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0122
Total number of active participants reported on line 7a of the Form 55002020-01-0119
Number of retired or separated participants receiving benefits2020-01-015
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0124
Number of participants with account balances2020-01-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0123
Total number of active participants reported on line 7a of the Form 55002019-01-0122
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-0122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0122
Number of participants with account balances2019-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0117
Total number of active participants reported on line 7a of the Form 55002018-01-0123
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0123
Number of participants with account balances2018-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0118
Total number of active participants reported on line 7a of the Form 55002017-01-0117
Number of retired or separated participants receiving benefits2017-01-018
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0125
Number of participants with account balances2017-01-0125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0118
Total number of active participants reported on line 7a of the Form 55002016-01-0117
Number of retired or separated participants receiving benefits2016-01-011
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0118
Number of participants with account balances2016-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0116
Total number of active participants reported on line 7a of the Form 55002015-01-0117
Number of retired or separated participants receiving benefits2015-01-011
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0118
Number of participants with account balances2015-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0111
Total number of active participants reported on line 7a of the Form 55002014-01-0116
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0116
Number of participants with account balances2014-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0112
Total number of active participants reported on line 7a of the Form 55002013-01-0111
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0111
Number of participants with account balances2013-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0112
Total number of active participants reported on line 7a of the Form 55002012-01-0112
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0112
Number of participants with account balances2012-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-010
Total number of active participants reported on line 7a of the Form 55002011-01-0112
Number of retired or separated participants receiving benefits2011-01-010
Total of all active and inactive participants2011-01-0112
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0112
Number of participants with account balances2011-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010

Financial Data on LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN

Measure Date Value
2022 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2022 401k financial data
Total income from all sources2022-12-31$-84,209
Expenses. Total of all expenses incurred2022-12-31$1,540
Benefits paid (including direct rollovers)2022-12-31$1,340
Total plan assets at end of year2022-12-31$1,143,940
Total plan assets at beginning of year2022-12-31$1,229,689
Value of fidelity bond covering the plan2022-12-31$120,000
Total contributions received or receivable from participants2022-12-31$76,863
Other income received2022-12-31$-193,102
Net income (gross income less expenses)2022-12-31$-85,749
Net plan assets at end of year (total assets less liabilities)2022-12-31$1,143,940
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$1,229,689
Assets. Value of participant loans2022-12-31$9,871
Total contributions received or receivable from employer(s)2022-12-31$32,030
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$200
2021 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2021 401k financial data
Total income from all sources2021-12-31$247,722
Expenses. Total of all expenses incurred2021-12-31$59,933
Benefits paid (including direct rollovers)2021-12-31$59,758
Total plan assets at end of year2021-12-31$1,229,689
Total plan assets at beginning of year2021-12-31$1,041,900
Value of fidelity bond covering the plan2021-12-31$130,000
Total contributions received or receivable from participants2021-12-31$67,478
Other income received2021-12-31$149,571
Net income (gross income less expenses)2021-12-31$187,789
Net plan assets at end of year (total assets less liabilities)2021-12-31$1,229,689
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$1,041,900
Assets. Value of participant loans2021-12-31$11,105
Total contributions received or receivable from employer(s)2021-12-31$30,673
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$175
2020 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2020 401k financial data
Total income from all sources2020-12-31$184,991
Expenses. Total of all expenses incurred2020-12-31$41,708
Benefits paid (including direct rollovers)2020-12-31$41,508
Total plan assets at end of year2020-12-31$1,041,900
Total plan assets at beginning of year2020-12-31$898,617
Value of fidelity bond covering the plan2020-12-31$110,000
Total contributions received or receivable from participants2020-12-31$63,205
Other income received2020-12-31$94,915
Net income (gross income less expenses)2020-12-31$143,283
Net plan assets at end of year (total assets less liabilities)2020-12-31$1,041,900
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$898,617
Assets. Value of participant loans2020-12-31$14,477
Total contributions received or receivable from employer(s)2020-12-31$26,871
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$200
2019 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2019 401k financial data
Total income from all sources2019-12-31$222,653
Expenses. Total of all expenses incurred2019-12-31$17,687
Benefits paid (including direct rollovers)2019-12-31$17,537
Total plan assets at end of year2019-12-31$898,617
Total plan assets at beginning of year2019-12-31$693,651
Value of fidelity bond covering the plan2019-12-31$90,000
Total contributions received or receivable from participants2019-12-31$53,426
Other income received2019-12-31$144,302
Net income (gross income less expenses)2019-12-31$204,966
Net plan assets at end of year (total assets less liabilities)2019-12-31$898,617
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$693,651
Assets. Value of participant loans2019-12-31$24,696
Total contributions received or receivable from employer(s)2019-12-31$24,925
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$150
2018 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2018 401k financial data
Total income from all sources2018-12-31$5,304
Expenses. Total of all expenses incurred2018-12-31$33,663
Benefits paid (including direct rollovers)2018-12-31$33,588
Total plan assets at end of year2018-12-31$693,651
Total plan assets at beginning of year2018-12-31$722,010
Value of fidelity bond covering the plan2018-12-31$80,000
Total contributions received or receivable from participants2018-12-31$51,658
Other income received2018-12-31$-73,032
Net income (gross income less expenses)2018-12-31$-28,359
Net plan assets at end of year (total assets less liabilities)2018-12-31$693,651
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$722,010
Assets. Value of participant loans2018-12-31$36,284
Total contributions received or receivable from employer(s)2018-12-31$26,678
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$75
2017 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2017 401k financial data
Total income from all sources2017-12-31$197,533
Expenses. Total of all expenses incurred2017-12-31$50
Total plan assets at end of year2017-12-31$722,010
Total plan assets at beginning of year2017-12-31$524,527
Value of fidelity bond covering the plan2017-12-31$80,000
Total contributions received or receivable from participants2017-12-31$54,135
Contributions received from other sources (not participants or employers)2017-12-31$26,583
Other income received2017-12-31$90,882
Net income (gross income less expenses)2017-12-31$197,483
Net plan assets at end of year (total assets less liabilities)2017-12-31$722,010
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$524,527
Assets. Value of participant loans2017-12-31$20,275
Total contributions received or receivable from employer(s)2017-12-31$25,933
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$50
2016 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2016 401k financial data
Total income from all sources2016-12-31$103,714
Expenses. Total of all expenses incurred2016-12-31$50
Total plan assets at end of year2016-12-31$524,527
Total plan assets at beginning of year2016-12-31$420,863
Value of fidelity bond covering the plan2016-12-31$60,000
Total contributions received or receivable from participants2016-12-31$46,899
Assets. Value of loans (other than to participants)2016-12-31$0
Other income received2016-12-31$35,272
Net income (gross income less expenses)2016-12-31$103,664
Net plan assets at end of year (total assets less liabilities)2016-12-31$524,527
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$420,863
Assets. Value of participant loans2016-12-31$29,962
Total contributions received or receivable from employer(s)2016-12-31$21,543
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$50
2015 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2015 401k financial data
Total income from all sources2015-12-31$55,581
Expenses. Total of all expenses incurred2015-12-31$7,538
Benefits paid (including direct rollovers)2015-12-31$7,488
Total plan assets at end of year2015-12-31$420,863
Total plan assets at beginning of year2015-12-31$372,820
Value of fidelity bond covering the plan2015-12-31$60,000
Total contributions received or receivable from participants2015-12-31$45,750
Assets. Value of loans (other than to participants)2015-12-31$0
Other income received2015-12-31$-9,903
Net income (gross income less expenses)2015-12-31$48,043
Net plan assets at end of year (total assets less liabilities)2015-12-31$420,863
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$372,820
Assets. Value of participant loans2015-12-31$39,594
Total contributions received or receivable from employer(s)2015-12-31$19,734
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$50
2014 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2014 401k financial data
Total income from all sources2014-12-31$67,880
Total plan assets at end of year2014-12-31$372,820
Total plan assets at beginning of year2014-12-31$304,940
Value of fidelity bond covering the plan2014-12-31$40,000
Total contributions received or receivable from participants2014-12-31$37,555
Assets. Value of loans (other than to participants)2014-12-31$48,872
Other income received2014-12-31$15,245
Net income (gross income less expenses)2014-12-31$67,880
Net plan assets at end of year (total assets less liabilities)2014-12-31$372,820
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$304,940
Total contributions received or receivable from employer(s)2014-12-31$15,080
2013 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2013 401k financial data
Total income from all sources2013-12-31$90,247
Expenses. Total of all expenses incurred2013-12-31$13,568
Benefits paid (including direct rollovers)2013-12-31$13,568
Total plan assets at end of year2013-12-31$304,940
Total plan assets at beginning of year2013-12-31$228,261
Total contributions received or receivable from participants2013-12-31$29,954
Other income received2013-12-31$46,854
Net income (gross income less expenses)2013-12-31$76,679
Net plan assets at end of year (total assets less liabilities)2013-12-31$304,940
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$228,261
Total contributions received or receivable from employer(s)2013-12-31$13,439
2012 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2012 401k financial data
Total income from all sources2012-12-31$69,827
Expenses. Total of all expenses incurred2012-12-31$3,720
Benefits paid (including direct rollovers)2012-12-31$3,720
Total plan assets at end of year2012-12-31$228,261
Total plan assets at beginning of year2012-12-31$162,154
Total contributions received or receivable from participants2012-12-31$30,711
Other income received2012-12-31$24,967
Net income (gross income less expenses)2012-12-31$66,107
Net plan assets at end of year (total assets less liabilities)2012-12-31$228,261
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$162,154
Total contributions received or receivable from employer(s)2012-12-31$14,149
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$3,720
2011 : LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$130,196
Total income from all sources2011-12-31$31,958
Total plan assets at end of year2011-12-31$162,154
Total plan assets at beginning of year2011-12-31$0
Total contributions received or receivable from participants2011-12-31$29,865
Other income received2011-12-31$-10,712
Net income (gross income less expenses)2011-12-31$31,958
Net plan assets at end of year (total assets less liabilities)2011-12-31$162,154
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$12,805

Form 5500 Responses for LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN

2022: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: LAKESIDE COMPREHENSIVE REHABILITATION INC 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01First time form 5500 has been submittedYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan 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 number943837-0
Policy instance 1
Insurance contract or identification number943837-0
Number of Individuals Covered24
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,584
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,792
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number943837-0
Policy instance 1
Insurance contract or identification number943837-0
Number of Individuals Covered24
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,761
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number943837-0
Policy instance 1
Insurance contract or identification number943837-0
Number of Individuals Covered23
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,268
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,134
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number943837-0
Policy instance 1
Insurance contract or identification number943837-0
Number of Individuals Covered23
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,031
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number943837-0
Policy instance 1
Insurance contract or identification number943837-0
Number of Individuals Covered23
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,621
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number943837-0
Policy instance 1
Insurance contract or identification number943837-0
Number of Individuals Covered25
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,934
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,934
Insurance broker organization code?3
Insurance broker nameDANIEL DEWITT

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