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GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1 401k Plan overview

Plan NameGENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1
Plan identification number 006

GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1 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.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

GENESIS ADMINISTRATIVE SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name:GENESIS ADMINISTRATIVE SERVICES, LLC
Employer identification number (EIN):300847166
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0062022-01-01
0062021-01-01
0062020-11-23

Plan Statistics for GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1

401k plan membership statisitcs for GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1

Measure Date Value
2022: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1 2022 401k membership
Total participants, beginning-of-year2022-01-0125,891
Total number of active participants reported on line 7a of the Form 55002022-01-0114,027
Number of retired or separated participants receiving benefits2022-01-0188
Number of other retired or separated participants entitled to future benefits2022-01-018,460
Total of all active and inactive participants2022-01-0122,575
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-0122,575
Number of participants with account balances2022-01-0122,575
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0127
2021: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1 2021 401k membership
Total participants, beginning-of-year2021-01-0132,252
Total number of active participants reported on line 7a of the Form 55002021-01-0116,594
Number of retired or separated participants receiving benefits2021-01-0171
Number of other retired or separated participants entitled to future benefits2021-01-019,225
Total of all active and inactive participants2021-01-0125,890
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-011
Total participants2021-01-0125,891
Number of participants with account balances2021-01-0125,891
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-0156
2020: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1 2020 401k membership
Total participants, beginning-of-year2020-11-2332,904
Total number of active participants reported on line 7a of the Form 55002020-11-2323,846
Number of retired or separated participants receiving benefits2020-11-2363
Number of other retired or separated participants entitled to future benefits2020-11-238,342
Total of all active and inactive participants2020-11-2332,251
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-11-231
Total participants2020-11-2332,252
Number of participants with account balances2020-11-2317,808
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-11-23145

Financial Data on GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1

Measure Date Value
2022 : GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total transfer of assets to this plan2022-12-31$348,355
Total transfer of assets from this plan2022-12-31$11,492,970
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-126,899,455
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$106,648,595
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$104,961,557
Expenses. Certain deemed distributions of participant loans2022-12-31$250,979
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$55,566,793
Value of total assets at end of year2022-12-31$780,401,911
Value of total assets at beginning of year2022-12-31$1,025,094,576
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$1,436,059
Total interest from all sources2022-12-31$254,415
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$2,497,467
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$2,497,467
Administrative expenses professional fees incurred2022-12-31$43,250
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$10,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$52,916,099
Participant contributions at end of year2022-12-31$5,870,692
Participant contributions at beginning of year2022-12-31$6,586,862
Participant contributions at end of year2022-12-31$797,649
Participant contributions at beginning of year2022-12-31$832,119
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$2,603,293
Other income not declared elsewhere2022-12-31$253,148
Administrative expenses (other) incurred2022-12-31$271,074
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-233,548,050
Value of net assets at end of year (total assets less liabilities)2022-12-31$780,401,911
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$1,025,094,576
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$580,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$166,592,193
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$225,980,598
Value of interest in pooled separate accounts at end of year2022-12-31$122,671,484
Value of interest in pooled separate accounts at beginning of year2022-12-31$202,861,686
Interest on participant loans2022-12-31$254,415
Value of interest in common/collective trusts at end of year2022-12-31$484,422,492
Value of interest in common/collective trusts at beginning of year2022-12-31$588,833,311
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-44,553,050
Net investment gain/loss from pooled separate accounts2022-12-31$-57,937,691
Net investment gain or loss from common/collective trusts2022-12-31$-82,980,537
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$47,401
Employer contributions (assets) at end of year2022-12-31$47,401
Employer contributions (assets) at beginning of year2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$104,961,557
Contract administrator fees2022-12-31$541,735
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31EISNERAMPER LLP
Accountancy firm EIN2022-12-31871363769
2021 : GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total transfer of assets to this plan2021-12-31$363,640
Total transfer of assets from this plan2021-12-31$1,271,670
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$195,714,080
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$151,294,397
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$149,356,160
Expenses. Certain deemed distributions of participant loans2021-12-31$85,014
Value of total corrective distributions2021-12-31$548,337
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$66,035,607
Value of total assets at end of year2021-12-31$1,025,094,576
Value of total assets at beginning of year2021-12-31$981,582,923
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$1,304,886
Total interest from all sources2021-12-31$312,726
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$2,732,980
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$2,732,980
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$10,000,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$61,060,952
Participant contributions at end of year2021-12-31$6,586,862
Participant contributions at beginning of year2021-12-31$8,616,953
Participant contributions at end of year2021-12-31$832,119
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$4,974,568
Other income not declared elsewhere2021-12-31$172,551
Administrative expenses (other) incurred2021-12-31$1,304,886
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$44,419,683
Value of net assets at end of year (total assets less liabilities)2021-12-31$1,025,094,576
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$981,582,923
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$225,980,598
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$205,928,708
Value of interest in pooled separate accounts at end of year2021-12-31$202,861,686
Value of interest in pooled separate accounts at beginning of year2021-12-31$197,585,635
Interest on participant loans2021-12-31$312,726
Value of interest in common/collective trusts at end of year2021-12-31$588,833,311
Value of interest in common/collective trusts at beginning of year2021-12-31$569,451,627
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$38,231,788
Net investment gain/loss from pooled separate accounts2021-12-31$27,456,799
Net investment gain or loss from common/collective trusts2021-12-31$60,771,629
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$87
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$149,356,160
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31EISNERAMPER LLP
Accountancy firm EIN2021-12-31871363769
2020 : GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total transfer of assets to this plan2020-12-31$946,643,742
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$47,175,569
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$12,236,388
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$12,166,636
Expenses. Certain deemed distributions of participant loans2020-12-31$67,827
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$5,790,045
Value of total assets at end of year2020-12-31$981,582,923
Value of total assets at beginning of year2020-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$1,925
Total interest from all sources2020-12-31$50,611
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$850,035
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$850,035
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$10,000,000
If this is an individual account plan, was there a blackout period2020-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$5,590,978
Participant contributions at end of year2020-12-31$8,616,953
Participant contributions at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$197,356
Other income not declared elsewhere2020-12-31$-5
Administrative expenses (other) incurred2020-12-31$1,925
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$34,939,181
Value of net assets at end of year (total assets less liabilities)2020-12-31$981,582,923
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$205,928,708
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$0
Value of interest in pooled separate accounts at end of year2020-12-31$197,585,635
Value of interest in pooled separate accounts at beginning of year2020-12-31$0
Interest on participant loans2020-12-31$50,611
Value of interest in common/collective trusts at end of year2020-12-31$569,451,627
Value of interest in common/collective trusts at beginning of year2020-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$16,166,395
Net investment gain/loss from pooled separate accounts2020-12-31$6,682,876
Net investment gain or loss from common/collective trusts2020-12-31$17,635,612
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$1,711
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$12,166,636
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31Yes
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No

Form 5500 Responses for GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1

2022: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedYes
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedYes
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: GENESIS ADMINISTRATIVE SERVICES 401(K) PLAN #1 2020 form 5500 responses
2020-11-23Type of plan entitySingle employer plan
2020-11-23First time form 5500 has been submittedYes
2020-11-23Submission has been amendedNo
2020-11-23This submission is the final filingNo
2020-11-23This return/report is a short plan year return/report (less than 12 months)Yes
2020-11-23Plan is a collectively bargained planNo
2020-11-23Plan funding arrangement – InsuranceYes
2020-11-23Plan funding arrangement – TrustYes
2020-11-23Plan benefit arrangement – InsuranceYes
2020-11-23Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number064277
Policy instance 1
Insurance contract or identification number064277
Number of Individuals Covered22575
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number075551
Policy instance 2
Insurance contract or identification number075551
Number of Individuals Covered22575
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number064277
Policy instance 1
Insurance contract or identification number064277
Number of Individuals Covered25891
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number075551
Policy instance 2
Insurance contract or identification number075551
Number of Individuals Covered25891
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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?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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number064277
Policy instance 1
Insurance contract or identification number064277
Number of Individuals Covered17808
Insurance policy start date2020-11-30
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number075551
Policy instance 2
Insurance contract or identification number075551
Number of Individuals Covered17808
Insurance policy start date2020-11-23
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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?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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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