THE NORTH SIDE BANK & TRUST CO. has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022: NSB PROFIT SHARING 401K PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 106 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 13 |
| Total of all active and inactive participants | 2022-01-01 | 121 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2022-01-01 | 0 |
| Total participants | 2022-01-01 | 121 |
| Number of participants with account balances | 2022-01-01 | 111 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2022-01-01 | 1 |
| 2021: NSB PROFIT SHARING 401K PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 103 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 15 |
| Total of all active and inactive participants | 2021-01-01 | 118 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2021-01-01 | 0 |
| Total participants | 2021-01-01 | 118 |
| Number of participants with account balances | 2021-01-01 | 110 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2021-01-01 | 1 |
| 2020: NSB PROFIT SHARING 401K PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 105 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 20 |
| Total of all active and inactive participants | 2020-01-01 | 125 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2020-01-01 | 0 |
| Total participants | 2020-01-01 | 125 |
| Number of participants with account balances | 2020-01-01 | 125 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2020-01-01 | 0 |
| 2019: NSB PROFIT SHARING 401K PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 18 |
| Total of all active and inactive participants | 2019-01-01 | 118 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2019-01-01 | 0 |
| Total participants | 2019-01-01 | 118 |
| Number of participants with account balances | 2019-01-01 | 118 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2019-01-01 | 2 |
| 2018: NSB PROFIT SHARING 401K PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 98 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 17 |
| Total of all active and inactive participants | 2018-01-01 | 115 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 0 |
| Total participants | 2018-01-01 | 115 |
| Number of participants with account balances | 2018-01-01 | 115 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-01-01 | 3 |
| 2017: NSB PROFIT SHARING 401K PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 104 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 15 |
| Total of all active and inactive participants | 2017-01-01 | 119 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-01-01 | 0 |
| Total participants | 2017-01-01 | 119 |
| Number of participants with account balances | 2017-01-01 | 119 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-01-01 | 0 |
| 2016: NSB PROFIT SHARING 401K PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 113 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 98 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 15 |
| Total of all active and inactive participants | 2016-01-01 | 113 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-01-01 | 0 |
| Total participants | 2016-01-01 | 113 |
| Number of participants with account balances | 2016-01-01 | 113 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-01-01 | 0 |
| 2015: NSB PROFIT SHARING 401K PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 94 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 19 |
| Total of all active and inactive participants | 2015-01-01 | 113 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2015-01-01 | 0 |
| Total participants | 2015-01-01 | 113 |
| Number of participants with account balances | 2015-01-01 | 113 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2015-01-01 | 0 |
| 2014: NSB PROFIT SHARING 401K PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 99 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 13 |
| Total of all active and inactive participants | 2014-01-01 | 112 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-01-01 | 0 |
| Total participants | 2014-01-01 | 112 |
| Number of participants with account balances | 2014-01-01 | 112 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-01-01 | 1 |
| 2013: NSB PROFIT SHARING 401K PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 110 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 95 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 17 |
| Total of all active and inactive participants | 2013-01-01 | 112 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 2 |
| Total participants | 2013-01-01 | 114 |
| Number of participants with account balances | 2013-01-01 | 114 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-01-01 | 0 |
| 2012: NSB PROFIT SHARING 401K PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 88 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 20 |
| Total of all active and inactive participants | 2012-01-01 | 108 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 2 |
| Total participants | 2012-01-01 | 110 |
| Number of participants with account balances | 2012-01-01 | 110 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-01-01 | 0 |
| 2011: NSB PROFIT SHARING 401K PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 93 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 17 |
| Total of all active and inactive participants | 2011-01-01 | 110 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-01-01 | 2 |
| Total participants | 2011-01-01 | 112 |
| Number of participants with account balances | 2011-01-01 | 112 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-01-01 | 1 |
| 2010: NSB PROFIT SHARING 401K PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 97 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 19 |
| Total of all active and inactive participants | 2010-01-01 | 116 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 2 |
| Total participants | 2010-01-01 | 118 |
| Number of participants with account balances | 2010-01-01 | 118 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-01-01 | 0 |
| 2009: NSB PROFIT SHARING 401K PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 96 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 17 |
| Total of all active and inactive participants | 2009-01-01 | 113 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 2 |
| Total participants | 2009-01-01 | 115 |
| Number of participants with account balances | 2009-01-01 | 115 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 0 |
| Measure | Date | Value |
|---|
| 2022 : NSB PROFIT SHARING 401K PLAN 2022 401k financial data |
|---|
| Total income from all sources (including contributions) | 2022-12-31 | $-1,566,549 |
| Total of all expenses incurred | 2022-12-31 | $590,033 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $555,041 |
| Expenses. Certain deemed distributions of participant loans | 2022-12-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $873,024 |
| Value of total assets at end of year | 2022-12-31 | $14,795,292 |
| Value of total assets at beginning of year | 2022-12-31 | $16,951,874 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $34,992 |
| Total interest from all sources | 2022-12-31 | $31,409 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $461,953 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-12-31 | $461,953 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2022-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | Yes |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $414,419 |
| Participant contributions at end of year | 2022-12-31 | $0 |
| Participant contributions at end of year | 2022-12-31 | $17,832 |
| Participant contributions at beginning of year | 2022-12-31 | $15,165 |
| Assets. Other investments not covered elsewhere at end of year | 2022-12-31 | $53,894 |
| Assets. Other investments not covered elsewhere at beginning of year | 2022-12-31 | $65,435 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2022-12-31 | $8,605 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $0 |
| Administrative expenses (other) incurred | 2022-12-31 | $649 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-2,156,582 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $14,795,292 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $16,951,874 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Investment advisory and management fees | 2022-12-31 | $16,101 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-12-31 | $11,955,839 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-12-31 | $15,172,535 |
| Interest on participant loans | 2022-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-12-31 | $31,409 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2022-12-31 | $2,317,727 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2022-12-31 | $1,248,739 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $0 |
| Asset value of US Government securities at beginning of year | 2022-12-31 | $0 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-12-31 | $-2,932,935 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $450,000 |
| Employer contributions (assets) at end of year | 2022-12-31 | $450,000 |
| Employer contributions (assets) at beginning of year | 2022-12-31 | $450,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $555,041 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2022-12-31 | $0 |
| Contract administrator fees | 2022-12-31 | $18,242 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-12-31 | Yes |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2022-12-31 | $0 |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | BARNES, DENNIG & CO., LTD |
| Accountancy firm EIN | 2022-12-31 | 311119890 |
| 2021 : NSB PROFIT SHARING 401K PLAN 2021 401k financial data |
|---|
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $1,852 |
| Total income from all sources (including contributions) | 2021-12-31 | $3,280,280 |
| Total of all expenses incurred | 2021-12-31 | $2,900,516 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $2,852,566 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $857,675 |
| Value of total assets at end of year | 2021-12-31 | $16,951,874 |
| Value of total assets at beginning of year | 2021-12-31 | $16,573,962 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $47,950 |
| Total interest from all sources | 2021-12-31 | $32,838 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-12-31 | $661,518 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2021-12-31 | $661,518 |
| Assets. Corporate prefeered stocks other than exployer securities at end of year | 2021-12-31 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2021-12-31 | $20,000 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | Yes |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2021-12-31 | $0 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $393,159 |
| Participant contributions at end of year | 2021-12-31 | $15,165 |
| Participant contributions at beginning of year | 2021-12-31 | $16,457 |
| Assets. Other investments not covered elsewhere at end of year | 2021-12-31 | $65,435 |
| Assets. Other investments not covered elsewhere at beginning of year | 2021-12-31 | $75,534 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2021-12-31 | $15,286 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $2,909 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-12-31 | $1,852 |
| Other income not declared elsewhere | 2021-12-31 | $20,933 |
| Administrative expenses (other) incurred | 2021-12-31 | $8,113 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $379,764 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $16,951,874 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $16,572,110 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Investment advisory and management fees | 2021-12-31 | $39,837 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-12-31 | $15,172,535 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-12-31 | $7,830,852 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $77,617 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $77,617 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-12-31 | $32,838 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2021-12-31 | $1,248,739 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2021-12-31 | $820,857 |
| Asset value of US Government securities at end of year | 2021-12-31 | $0 |
| Asset value of US Government securities at beginning of year | 2021-12-31 | $221,400 |
| Net investment gain/loss from pooled separate accounts | 2021-12-31 | $1,707,316 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $449,230 |
| Employer contributions (assets) at end of year | 2021-12-31 | $450,000 |
| Employer contributions (assets) at beginning of year | 2021-12-31 | $449,174 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $2,852,566 |
| Asset. Corporate debt instrument debt (other) at end of year | 2021-12-31 | $0 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2021-12-31 | $1,431,383 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-12-31 | Yes |
| Assets. Corporate common stocks other than exployer securities at end of year | 2021-12-31 | $0 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2021-12-31 | $5,627,779 |
| Did the plan have assets held for investment | 2021-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | BARNES, DENNIG & CO., LTD |
| Accountancy firm EIN | 2021-12-31 | 311119890 |
| 2020 : NSB PROFIT SHARING 401K PLAN 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $2,535,691 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $2,390,669 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $2,388,817 |
| Total plan assets at end of year | 2020-12-31 | $16,572,110 |
| Total plan assets at beginning of year | 2020-12-31 | $16,427,088 |
| Value of fidelity bond covering the plan | 2020-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2020-12-31 | $384,576 |
| Contributions received from other sources (not participants or employers) | 2020-12-31 | $54,317 |
| Other income received | 2020-12-31 | $1,646,798 |
| Net income (gross income less expenses) | 2020-12-31 | $145,022 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $16,572,110 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $16,427,088 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $450,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $1,852 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2020-12-31 | $0 |
| 2019 : NSB PROFIT SHARING 401K PLAN 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $3,719,713 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $1,229,561 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $1,226,482 |
| Total plan assets at end of year | 2019-12-31 | $16,427,088 |
| Total plan assets at beginning of year | 2019-12-31 | $13,936,936 |
| Value of fidelity bond covering the plan | 2019-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2019-12-31 | $402,968 |
| Contributions received from other sources (not participants or employers) | 2019-12-31 | $7,359 |
| Other income received | 2019-12-31 | $2,859,386 |
| Net income (gross income less expenses) | 2019-12-31 | $2,490,152 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $16,427,088 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $13,936,936 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $450,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $3,079 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2019-12-31 | $0 |
| 2018 : NSB PROFIT SHARING 401K PLAN 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $70,529 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $1,034,830 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $1,030,751 |
| Total plan assets at end of year | 2018-12-31 | $13,936,936 |
| Total plan assets at beginning of year | 2018-12-31 | $14,901,237 |
| Value of fidelity bond covering the plan | 2018-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $388,785 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $1,000 |
| Other income received | 2018-12-31 | $-768,256 |
| Net income (gross income less expenses) | 2018-12-31 | $-964,301 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $13,936,936 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $14,901,237 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $450,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $3,079 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2018-12-31 | $0 |
| 2017 : NSB PROFIT SHARING 401K PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $2,664,811 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $567,279 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $562,800 |
| Total plan assets at end of year | 2017-12-31 | $14,901,237 |
| Total plan assets at beginning of year | 2017-12-31 | $12,803,705 |
| Value of fidelity bond covering the plan | 2017-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $368,490 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $1,400 |
| Other income received | 2017-12-31 | $1,925,073 |
| Net income (gross income less expenses) | 2017-12-31 | $2,097,532 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $14,901,237 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $12,803,705 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $371,248 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $3,079 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2017-12-31 | $0 |
| 2016 : NSB PROFIT SHARING 401K PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $1,761,436 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $889,499 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $884,620 |
| Total plan assets at end of year | 2016-12-31 | $12,803,705 |
| Total plan assets at beginning of year | 2016-12-31 | $11,931,768 |
| Value of fidelity bond covering the plan | 2016-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $354,516 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $1,800 |
| Contributions received from other sources (not participants or employers) | 2016-12-31 | $4,889 |
| Other income received | 2016-12-31 | $1,032,031 |
| Net income (gross income less expenses) | 2016-12-31 | $871,937 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $12,803,705 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $11,931,768 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $370,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $3,079 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2016-12-31 | $0 |
| 2015 : NSB PROFIT SHARING 401K PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $573,614 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $2,024,473 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $2,019,758 |
| Total plan assets at end of year | 2015-12-31 | $11,931,768 |
| Total plan assets at beginning of year | 2015-12-31 | $13,382,627 |
| Value of fidelity bond covering the plan | 2015-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $342,479 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $1,400 |
| Other income received | 2015-12-31 | $-18,865 |
| Net income (gross income less expenses) | 2015-12-31 | $-1,450,859 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $11,931,768 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $13,382,627 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $250,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $3,315 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2015-12-31 | $0 |
| 2014 : NSB PROFIT SHARING 401K PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $1,729,385 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $1,542,168 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $1,537,389 |
| Total plan assets at end of year | 2014-12-31 | $13,382,627 |
| Total plan assets at beginning of year | 2014-12-31 | $13,195,410 |
| Value of fidelity bond covering the plan | 2014-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $331,316 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $600 |
| Other income received | 2014-12-31 | $1,148,069 |
| Net income (gross income less expenses) | 2014-12-31 | $187,217 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $13,382,627 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $13,195,410 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $250,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $4,179 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2014-12-31 | $0 |
| 2013 : NSB PROFIT SHARING 401K PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $2,656,747 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $349,893 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $345,714 |
| Total plan assets at end of year | 2013-12-31 | $13,195,410 |
| Total plan assets at beginning of year | 2013-12-31 | $10,888,556 |
| Value of fidelity bond covering the plan | 2013-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $306,534 |
| Other income received | 2013-12-31 | $2,130,213 |
| Net income (gross income less expenses) | 2013-12-31 | $2,306,854 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $13,195,410 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $10,888,556 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $220,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $4,179 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2013-12-31 | $0 |
| 2012 : NSB PROFIT SHARING 401K PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $1,558,153 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $263,516 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $259,337 |
| Total plan assets at end of year | 2012-12-31 | $10,888,556 |
| Total plan assets at beginning of year | 2012-12-31 | $9,593,919 |
| Value of fidelity bond covering the plan | 2012-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2012-12-31 | $273,041 |
| Contributions received from other sources (not participants or employers) | 2012-12-31 | $35,149 |
| Other income received | 2012-12-31 | $1,029,963 |
| Net income (gross income less expenses) | 2012-12-31 | $1,294,637 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $10,888,556 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $9,593,919 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $220,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $4,179 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2012-12-31 | $0 |
| 2011 : NSB PROFIT SHARING 401K PLAN 2011 401k financial data |
|---|
| Total income from all sources | 2011-12-31 | $567,637 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $78,512 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $74,333 |
| Total plan assets at end of year | 2011-12-31 | $9,593,919 |
| Total plan assets at beginning of year | 2011-12-31 | $9,104,794 |
| Value of fidelity bond covering the plan | 2011-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2011-12-31 | $280,848 |
| Other income received | 2011-12-31 | $66,789 |
| Net income (gross income less expenses) | 2011-12-31 | $489,125 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $9,593,919 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $9,104,794 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $220,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-12-31 | $4,179 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2011-12-31 | $0 |
| 2010 : NSB PROFIT SHARING 401K PLAN 2010 401k financial data |
|---|
| Total income from all sources | 2010-12-31 | $1,365,539 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $146,407 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $141,228 |
| Total plan assets at end of year | 2010-12-31 | $9,104,794 |
| Total plan assets at beginning of year | 2010-12-31 | $7,885,662 |
| Value of fidelity bond covering the plan | 2010-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2010-12-31 | $266,191 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $1,000 |
| Other income received | 2010-12-31 | $879,348 |
| Net income (gross income less expenses) | 2010-12-31 | $1,219,132 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $9,104,794 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $7,885,662 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $220,000 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-12-31 | $4,179 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2010-12-31 | $0 |
| 2009 : NSB PROFIT SHARING 401K PLAN 2009 401k financial data |
|---|
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2009-12-31 | $0 |
| 2022: NSB PROFIT SHARING 401K PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021: NSB PROFIT SHARING 401K PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: NSB PROFIT SHARING 401K PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: NSB PROFIT SHARING 401K PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: NSB PROFIT SHARING 401K PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: NSB PROFIT SHARING 401K PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: NSB PROFIT SHARING 401K PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: NSB PROFIT SHARING 401K PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: NSB PROFIT SHARING 401K PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: NSB PROFIT SHARING 401K PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: NSB PROFIT SHARING 401K PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: NSB PROFIT SHARING 401K PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: NSB PROFIT SHARING 401K PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | Yes |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: NSB PROFIT SHARING 401K PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
| Policy contract number | 747260-01 |
| Policy instance | 3 |
| Insurance contract or identification number | 747260-01 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
| Policy contract number | GA836308 |
| Policy instance | 3 |
| Insurance contract or identification number | GA836308 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Contracts With Unallocated Funds Deposit Administration | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 1 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 4 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $38 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $38 | | Insurance broker organization code? | 3 |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2019-12-15 | | Insurance policy end date | 2020-12-14 | | Total amount of commissions paid to insurance broker | USD $31 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 |
|
| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
| Policy contract number | GA836308 |
| Policy instance | 3 |
| Insurance contract or identification number | GA836308 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 |
|
| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
| Policy contract number | GA836308 |
| Policy instance | 3 |
| Insurance contract or identification number | GA836308 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,509 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Amount paid for insurance broker fees | 1509 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE ALLOWANCE | | Insurance broker organization code? | 3 |
|
| JACKSON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65056 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2018-12-15 | | Insurance policy end date | 2019-12-14 | | Total amount of commissions paid to insurance broker | USD $31 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $31 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 |
|
| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
| Policy contract number | GA836308 |
| Policy instance | 3 |
| Insurance contract or identification number | GA836308 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,296 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Amount paid for insurance broker fees | 2296 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE ALLOWANCE | | Insurance broker organization code? | 3 |
|
| CONTINTAL ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62413 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2017-12-15 | | Insurance policy end date | 2018-12-14 | | Total amount of commissions paid to insurance broker | USD $31 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $53 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $53 | | Insurance broker organization code? | 3 |
|
| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
| Policy contract number | GA836308 |
| Policy instance | 3 |
| Insurance contract or identification number | GA836308 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,222 | | Total amount of fees paid to insurance company | USD $2,730 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $5,222 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2730 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE ALLOWANCE | | Insurance broker name | LPL FINANCIAL CORPORATION |
|
| CONTINTAL ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62413 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2016-12-15 | | Insurance policy end date | 2017-12-14 | | Total amount of commissions paid to insurance broker | USD $31 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $53 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $53 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-12-31 | | Total amount of commissions paid to insurance broker | USD $53 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $53 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
|
| CONTINTAL ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62413 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2015-12-15 | | Insurance policy end date | 2016-12-14 | | Total amount of commissions paid to insurance broker | USD $31 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
|
| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
| Policy contract number | GA836308 |
| Policy instance | 3 |
| Insurance contract or identification number | GA836308 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-12-31 | | Total amount of commissions paid to insurance broker | USD $4,080 | | Total amount of fees paid to insurance company | USD $625 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $4,080 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 625 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE ALLOWANCE | | Insurance broker name | ACTUARIAL & EMPLOYEE BENEFIT SVCS |
|
| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
| Policy contract number | GA836308 |
| Policy instance | 3 |
| Insurance contract or identification number | GA836308 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $24,695 | | Total amount of fees paid to insurance company | USD $7,500 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $24,695 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7500 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE ALLOWANCE | | Insurance broker name | ACTUARIAL & EMPLOYEE BENEFIT SVCS |
|
| CONTINTAL ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62413 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2014-12-15 | | Insurance policy end date | 2015-12-14 | | Total amount of commissions paid to insurance broker | USD $31 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $53 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $53 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $53 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $53 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
|
| CONTINTAL ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62413 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2013-12-15 | | Insurance policy end date | 2014-12-14 | | Total amount of commissions paid to insurance broker | USD $31 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
|
| CONTINTAL ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62413 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2012-12-15 | | Insurance policy end date | 2013-12-14 | | Total amount of commissions paid to insurance broker | USD $31 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
|
| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $53 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $53 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
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| CONTINTAL ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62413 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2011-12-15 | | Insurance policy end date | 2012-12-14 | | Total amount of commissions paid to insurance broker | USD $31 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $31 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
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| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $53 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $53 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, III |
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| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $53 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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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| CONTINTAL ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62413 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2010-12-15 | | Insurance policy end date | 2011-12-14 | | Total amount of commissions paid to insurance broker | USD $31 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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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| AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 ) |
| Policy contract number | GP5042 |
| Policy instance | 1 |
| Insurance contract or identification number | GP5042 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $130 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $130 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, JR. |
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| CONTINTAL ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62413 ) |
| Policy contract number | GP4105 |
| Policy instance | 2 |
| Insurance contract or identification number | GP4105 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2009-12-15 | | Insurance policy end date | 2010-12-14 | | Total amount of commissions paid to insurance broker | USD $100 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | | Commission paid to Insurance Broker | USD $100 | | Insurance broker organization code? | 3 | | Insurance broker name | CARL R. SCHLOTMAN, JR. |
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