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LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameLANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN
Plan identification number 002

LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

LANCASTER-FAIRFIELD COMMUNITY ACTION PROGRAM, INC. has sponsored the creation of one or more 401k plans.

Company Name:LANCASTER-FAIRFIELD COMMUNITY ACTION PROGRAM, INC.
Employer identification number (EIN):316060695
NAIC Classification:624200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01CLINTON DAVIS2023-09-19
0022021-01-01CLINTON DAVIS2022-09-28
0022020-01-01CLINTON DAVIS2021-10-07
0022019-01-01
0022018-01-01KELLIE A. AILES2019-06-11 JANET M. SCHMELZER2019-06-11
0022017-01-01KELLIE A. AILES2018-06-11 JANET M. SCHMELZER2018-06-11
0022016-01-01KELLIE A. AILES2017-06-19
0022015-01-01KELLIE A. AILES2016-08-24
0022014-01-01KELLIE A. AILES2015-06-22 KELLIE A. AILES2015-06-22
0022013-01-01KELLIE A. AILES2014-07-29 JANET M SCHMELZER2014-07-29
0022012-01-01KELLIE A. AILES2013-07-18
0022011-01-01KELLIE A. AILES2012-07-20
0022010-01-01KELLIE A. AILES2011-07-18

Plan Statistics for LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2022: LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01119
Total number of active participants reported on line 7a of the Form 55002022-01-0195
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0132
Total of all active and inactive participants2022-01-01127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01127
Number of participants with account balances2022-01-01127
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-017
2021: LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01133
Total number of active participants reported on line 7a of the Form 55002021-01-0191
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0122
Total of all active and inactive participants2021-01-01113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01113
Number of participants with account balances2021-01-01113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-018
2020: LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01120
Total number of active participants reported on line 7a of the Form 55002020-01-0192
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0132
Total of all active and inactive participants2020-01-01124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01124
Number of participants with account balances2020-01-01124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-015

Financial Data on LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN

Measure Date Value
2022 : LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-469,025
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$129,741
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$97,451
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$306,998
Value of total assets at end of year2022-12-31$3,219,176
Value of total assets at beginning of year2022-12-31$3,817,942
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$32,290
Total interest from all sources2022-12-31$2,365
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$55,141
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$55,141
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$1,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$112,543
Participant contributions at end of year2022-12-31$56,781
Participant contributions at beginning of year2022-12-31$46,216
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$4,257
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$471
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Liabilities. Value of operating payables at end of year2022-12-31$0
Liabilities. Value of operating payables at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Income. Non cash contributions2022-12-31$0
Value of net income/loss2022-12-31$-598,766
Value of net assets at end of year (total assets less liabilities)2022-12-31$3,219,176
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$3,817,942
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$32,290
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$2,988,320
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$3,584,842
Interest on participant loans2022-12-31$2,365
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$174,075
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$171,090
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-833,529
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Assets. Invements in employer securities at end of year2022-12-31$0
Assets. Invements in employer securities at beginning of year2022-12-31$0
Assets. Value of employer real property at end of year2022-12-31$0
Assets. Value of employer real property at beginning of year2022-12-31$0
Contributions received in cash from employer2022-12-31$194,455
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$11,066
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$97,451
Liabilities. Value of benefit claims payable at end of year2022-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2022-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2022-12-31$0
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Liabilities. Value of acquisition indebtedness at end of year2022-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2022-12-31$0
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31S.R. SNODGRASS, P.C.
Accountancy firm EIN2022-12-31251616561
2021 : LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$904
Total income from all sources (including contributions)2021-12-31$695,338
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$267,458
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$228,878
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$279,187
Value of total assets at end of year2021-12-31$3,817,942
Value of total assets at beginning of year2021-12-31$3,390,966
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$38,580
Total interest from all sources2021-12-31$2,864
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,000,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$85,599
Participant contributions at end of year2021-12-31$46,216
Participant contributions at beginning of year2021-12-31$61,909
Participant contributions at end of year2021-12-31$4,257
Participant contributions at beginning of year2021-12-31$2,773
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$471
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$539
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$904
Liabilities. Value of operating payables at end of year2021-12-31$0
Liabilities. Value of operating payables at beginning of year2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Income. Non cash contributions2021-12-31$0
Value of net income/loss2021-12-31$427,880
Value of net assets at end of year (total assets less liabilities)2021-12-31$3,817,942
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$3,390,062
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$38,580
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$3,584,842
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$3,148,938
Interest on participant loans2021-12-31$2,864
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$171,090
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$163,968
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$413,287
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Assets. Invements in employer securities at end of year2021-12-31$0
Assets. Invements in employer securities at beginning of year2021-12-31$0
Assets. Value of employer real property at end of year2021-12-31$0
Assets. Value of employer real property at beginning of year2021-12-31$0
Contributions received in cash from employer2021-12-31$193,588
Employer contributions (assets) at end of year2021-12-31$11,066
Employer contributions (assets) at beginning of year2021-12-31$12,839
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$228,878
Liabilities. Value of benefit claims payable at end of year2021-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2021-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2021-12-31$0
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Liabilities. Value of acquisition indebtedness at end of year2021-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2021-12-31$0
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31ZENO,POCKL,LILLY AND COPELAND,A.C.
Accountancy firm EIN2021-12-31463686044
2020 : LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$904
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$760,660
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$447,931
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$417,129
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$270,543
Value of total assets at end of year2020-12-31$3,390,966
Value of total assets at beginning of year2020-12-31$3,077,333
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$30,802
Total interest from all sources2020-12-31$3,362
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$71,869
Participant contributions at end of year2020-12-31$61,909
Participant contributions at beginning of year2020-12-31$77,558
Participant contributions at end of year2020-12-31$2,773
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$15,659
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$539
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$904
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$312,729
Value of net assets at end of year (total assets less liabilities)2020-12-31$3,390,062
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$3,077,333
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$30,802
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$3,148,938
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$2,545,604
Interest on participant loans2020-12-31$3,362
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$163,968
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$454,171
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$486,755
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$183,015
Employer contributions (assets) at end of year2020-12-31$12,839
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$417,129
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31ZENO,POCKL,LILLY AND COPELAND,A.C.
Accountancy firm EIN2020-12-31463686044

Form 5500 Responses for LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN

2022: LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: LANCASTER-FAIRFIELD CAP, INC. 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number194-70039
Policy instance 1
Insurance contract or identification number194-70039
Number of Individuals Covered127
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number194-70039
Policy instance 1
Insurance contract or identification number194-70039
Number of Individuals Covered113
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number194-70039
Policy instance 1
Insurance contract or identification number194-70039
Number of Individuals Covered124
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No

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