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FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 401k Plan overview

Plan NameFIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN
Plan identification number 004

FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN Benefits

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

FIRST NATIONAL BANK OF BELLEVUE has sponsored the creation of one or more 401k plans.

Company Name:FIRST NATIONAL BANK OF BELLEVUE
Employer identification number (EIN):344186000
NAIC Classification:522110
NAIC Description:Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0042022-01-01DAVID E. JARVIS2023-09-21 DAVID E. JARVIS2023-09-21
0042021-01-01DEAN J. MILLER2022-06-13 DEAN J. MILLER2022-06-13
0042020-01-01
0042019-01-01
0042018-01-01
0042017-01-01DAVID JARVIS DEAN J. MILLER2018-10-15
0042016-01-01DAVID JARVIS2017-10-12 DEAN J. MILLER2017-10-10
0042015-01-01DAVID JARVIS2016-09-26 DEAN J. MILLER2016-09-26
0042014-01-01DAVID JARVIS2015-09-14 DEAN J. MILLER2015-09-23
0042013-01-01DAVID JARVIS2014-09-11 DEAN J. MILLER2014-09-30
0042012-01-01DAVID JARVIS
0042011-01-01DAVID JARVIS
0042010-07-01DAVID JARVIS DAVID JARVIS2011-05-13

Plan Statistics for FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN

401k plan membership statisitcs for FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN

Measure Date Value
2022: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0181
Total number of active participants reported on line 7a of the Form 55002022-01-0172
Number of other retired or separated participants entitled to future benefits2022-01-0116
Total of all active and inactive participants2022-01-0188
Total participants2022-01-0188
Number of participants with account balances2022-01-0174
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-018
2021: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0168
Total number of active participants reported on line 7a of the Form 55002021-01-0157
Number of other retired or separated participants entitled to future benefits2021-01-0123
Total of all active and inactive participants2021-01-0180
Total participants2021-01-0180
Number of participants with account balances2021-01-0171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-018
2020: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0165
Total number of active participants reported on line 7a of the Form 55002020-01-0150
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0119
Total of all active and inactive participants2020-01-0169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0169
Number of participants with account balances2020-01-0169
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0111
2019: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0168
Total number of active participants reported on line 7a of the Form 55002019-01-0155
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0110
Total of all active and inactive participants2019-01-0165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0165
Number of participants with account balances2019-01-0165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-015
2018: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0166
Total number of active participants reported on line 7a of the Form 55002018-01-0160
Number of retired or separated participants receiving benefits2018-01-012
Number of other retired or separated participants entitled to future benefits2018-01-015
Total of all active and inactive participants2018-01-0167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0167
Number of participants with account balances2018-01-0167
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-011
2017: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0162
Total number of active participants reported on line 7a of the Form 55002017-01-0156
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-019
Total of all active and inactive participants2017-01-0165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0165
Number of participants with account balances2017-01-0165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-012
2012: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0146
Total number of active participants reported on line 7a of the Form 55002012-01-0141
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-018
Total of all active and inactive participants2012-01-0149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0149
Number of participants with account balances2012-01-0148
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-015
2011: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0143
Total number of active participants reported on line 7a of the Form 55002011-01-0143
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-013
Total of all active and inactive participants2011-01-0146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0146
Number of participants with account balances2011-01-0144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-012
2010: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-07-0143
Total number of active participants reported on line 7a of the Form 55002010-07-0142
Number of retired or separated participants receiving benefits2010-07-010
Number of other retired or separated participants entitled to future benefits2010-07-011
Total of all active and inactive participants2010-07-0143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-07-010
Total participants2010-07-0143
Number of participants with account balances2010-07-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-07-010

Financial Data on FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN

Measure Date Value
2022 : FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2022 401k financial data
Total income from all sources2022-12-31$-737,733
Expenses. Total of all expenses incurred2022-12-31$418,495
Benefits paid (including direct rollovers)2022-12-31$413,277
Total plan assets at end of year2022-12-31$5,277,661
Total plan assets at beginning of year2022-12-31$6,433,889
Value of fidelity bond covering the plan2022-12-31$1,000,000
Total contributions received or receivable from participants2022-12-31$238,343
Contributions received from other sources (not participants or employers)2022-12-31$10,583
Other income received2022-12-31$-1,058,397
Net income (gross income less expenses)2022-12-31$-1,156,228
Net plan assets at end of year (total assets less liabilities)2022-12-31$5,277,661
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$6,433,889
Assets. Value of participant loans2022-12-31$49,225
Assets. Value of employer securities2022-12-31$290,228
Total contributions received or receivable from employer(s)2022-12-31$71,738
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$5,218
2021 : FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2021 401k financial data
Total income from all sources2021-12-31$1,237,404
Expenses. Total of all expenses incurred2021-12-31$402,180
Benefits paid (including direct rollovers)2021-12-31$397,031
Total plan assets at end of year2021-12-31$6,433,889
Total plan assets at beginning of year2021-12-31$5,598,665
Value of fidelity bond covering the plan2021-12-31$1,000,000
Total contributions received or receivable from participants2021-12-31$239,145
Expenses. Other expenses not covered elsewhere2021-12-31$5,149
Contributions received from other sources (not participants or employers)2021-12-31$10,082
Other income received2021-12-31$781,758
Net income (gross income less expenses)2021-12-31$835,224
Net plan assets at end of year (total assets less liabilities)2021-12-31$6,433,889
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$5,598,665
Assets. Value of participant loans2021-12-31$63,845
Assets. Value of employer securities2021-12-31$369,419
Total contributions received or receivable from employer(s)2021-12-31$206,419
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
2020 : FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$0
Total plan liabilities at beginning of year2020-12-31$0
Total income from all sources2020-12-31$1,102,849
Expenses. Total of all expenses incurred2020-12-31$979,584
Benefits paid (including direct rollovers)2020-12-31$967,884
Total plan assets at end of year2020-12-31$5,598,665
Total plan assets at beginning of year2020-12-31$5,475,400
Value of fidelity bond covering the plan2020-12-31$1,000,000
Total contributions received or receivable from participants2020-12-31$224,107
Contributions received from other sources (not participants or employers)2020-12-31$7,606
Other income received2020-12-31$689,124
Net income (gross income less expenses)2020-12-31$123,265
Net plan assets at end of year (total assets less liabilities)2020-12-31$5,598,665
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$5,475,400
Assets. Value of participant loans2020-12-31$105,198
Assets. Value of employer securities2020-12-31$225,114
Total contributions received or receivable from employer(s)2020-12-31$182,012
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$11,700
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$0
Total plan liabilities at beginning of year2019-12-31$0
Total income from all sources2019-12-31$1,250,996
Expenses. Total of all expenses incurred2019-12-31$281,489
Benefits paid (including direct rollovers)2019-12-31$275,555
Total plan assets at end of year2019-12-31$5,475,400
Total plan assets at beginning of year2019-12-31$4,505,893
Value of fidelity bond covering the plan2019-12-31$1,000,000
Total contributions received or receivable from participants2019-12-31$256,257
Other income received2019-12-31$809,551
Net income (gross income less expenses)2019-12-31$969,507
Net plan assets at end of year (total assets less liabilities)2019-12-31$5,475,400
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$4,505,893
Assets. Value of participant loans2019-12-31$104,385
Assets. Value of employer securities2019-12-31$171,430
Total contributions received or receivable from employer(s)2019-12-31$185,188
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$5,934
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2018 401k financial data
Total income from all sources2018-12-31$383,492
Expenses. Total of all expenses incurred2018-12-31$313,057
Benefits paid (including direct rollovers)2018-12-31$312,822
Total plan assets at end of year2018-12-31$4,505,893
Total plan assets at beginning of year2018-12-31$4,435,458
Value of fidelity bond covering the plan2018-12-31$1,000,000
Total contributions received or receivable from participants2018-12-31$236,645
Contributions received from other sources (not participants or employers)2018-12-31$185,366
Other income received2018-12-31$-294,194
Net income (gross income less expenses)2018-12-31$70,435
Net plan assets at end of year (total assets less liabilities)2018-12-31$4,505,893
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$4,435,458
Assets. Value of participant loans2018-12-31$65,006
Assets. Value of employer securities2018-12-31$118,248
Total contributions received or receivable from employer(s)2018-12-31$255,675
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$235
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2017 401k financial data
Total income from all sources2017-12-31$1,118,779
Expenses. Total of all expenses incurred2017-12-31$408,521
Benefits paid (including direct rollovers)2017-12-31$392,310
Total plan assets at end of year2017-12-31$4,435,458
Total plan assets at beginning of year2017-12-31$3,725,200
Value of fidelity bond covering the plan2017-12-31$1,000,000
Total contributions received or receivable from participants2017-12-31$214,509
Contributions received from other sources (not participants or employers)2017-12-31$16,724
Other income received2017-12-31$565,449
Net income (gross income less expenses)2017-12-31$710,258
Net plan assets at end of year (total assets less liabilities)2017-12-31$4,435,458
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$3,725,200
Assets. Value of participant loans2017-12-31$51,567
Assets. Value of employer securities2017-12-31$30,611
Total contributions received or receivable from employer(s)2017-12-31$322,097
Value of certain deemed distributions of participant loans2017-12-31$9,128
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$7,083
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2012 : FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2012 401k financial data
Total income from all sources2012-12-31$433,869
Expenses. Total of all expenses incurred2012-12-31$68,897
Benefits paid (including direct rollovers)2012-12-31$52,935
Total plan assets at end of year2012-12-31$2,246,012
Total plan assets at beginning of year2012-12-31$1,881,040
Value of fidelity bond covering the plan2012-12-31$1,000,000
Total contributions received or receivable from participants2012-12-31$100,145
Expenses. Other expenses not covered elsewhere2012-12-31$1,138
Other income received2012-12-31$256,788
Net income (gross income less expenses)2012-12-31$364,972
Net plan assets at end of year (total assets less liabilities)2012-12-31$2,246,012
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,881,040
Assets. Value of participant loans2012-12-31$42,994
Total contributions received or receivable from employer(s)2012-12-31$76,936
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$14,824
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2011 401k financial data
Total income from all sources2011-12-31$180,137
Expenses. Total of all expenses incurred2011-12-31$207,110
Benefits paid (including direct rollovers)2011-12-31$188,041
Total plan assets at end of year2011-12-31$1,881,040
Total plan assets at beginning of year2011-12-31$1,908,013
Value of fidelity bond covering the plan2011-12-31$1,000,000
Total contributions received or receivable from participants2011-12-31$97,436
Expenses. Other expenses not covered elsewhere2011-12-31$1,082
Other income received2011-12-31$41,849
Net income (gross income less expenses)2011-12-31$-26,973
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,881,040
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,908,013
Assets. Value of participant loans2011-12-31$61,311
Total contributions received or receivable from employer(s)2011-12-31$40,852
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$17,987
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$1,605,879
Total income from all sources2010-12-31$347,277
Expenses. Total of all expenses incurred2010-12-31$45,143
Benefits paid (including direct rollovers)2010-12-31$44,963
Total plan assets at end of year2010-12-31$1,908,013
Total plan assets at beginning of year2010-12-31$0
Value of fidelity bond covering the plan2010-12-31$1,000,000
Total contributions received or receivable from participants2010-12-31$61,853
Other income received2010-12-31$262,699
Net income (gross income less expenses)2010-12-31$302,134
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,908,013
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$0
Assets. Value of participant loans2010-12-31$59,126
Total contributions received or receivable from employer(s)2010-12-31$22,725
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$180
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0

Form 5500 Responses for FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN

2022: FIRST NATIONAL BANK OF BELLEVUE 401(K) 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 – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: FIRST NATIONAL BANK OF BELLEVUE 401(K) 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 - TrustYes
2020: FIRST NATIONAL BANK OF BELLEVUE 401(K) 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 - TrustYes
2019: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2012: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2010: FIRST NATIONAL BANK OF BELLEVUE 401(K) PLAN 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – TrustYes
2010-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number515-80301
Policy instance 1
Insurance contract or identification number515-80301
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 types other than group deferred annuity or individual?Yes
Other information about contractGUARANTEED INVESTMENT
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number515-80301
Policy instance 1
Insurance contract or identification number515-80301
Number of Individuals Covered10
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,989
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?Yes
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
Other information about contractGUARANTEED INVESTMENT
Commission paid to Insurance BrokerUSD $1,989
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number515-80301
Policy instance 1
Insurance contract or identification number515-80301
Number of Individuals Covered8
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,930
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?Yes
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
Other information about contractGUARANTEED INVESTMENT
Commission paid to Insurance BrokerUSD $1,930
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number515-80301
Policy instance 1
Insurance contract or identification number515-80301
Number of Individuals Covered9
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,381
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?Yes
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
Other information about contractGUARANTEED INVESTMENT
Commission paid to Insurance BrokerUSD $1,381
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number515-80301
Policy instance 1
Insurance contract or identification number515-80301
Number of Individuals Covered10
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $997
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?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGUARANTEED INVESTMENT
Commission paid to Insurance BrokerUSD $997
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameINFINEX INVESTMENTS, INC.

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