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DOOR SYSTEMS 401(K) PLAN 401k Plan overview

Plan NameDOOR SYSTEMS 401(K) PLAN
Plan identification number 001

DOOR SYSTEMS 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

DOOR SYSTEMS ASSA ABLOY US, INC. has sponsored the creation of one or more 401k plans.

Company Name:DOOR SYSTEMS ASSA ABLOY US, INC.
Employer identification number (EIN):364456973
NAIC Classification:333200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DOOR SYSTEMS 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01

Plan Statistics for DOOR SYSTEMS 401(K) PLAN

401k plan membership statisitcs for DOOR SYSTEMS 401(K) PLAN

Measure Date Value
2022: DOOR SYSTEMS 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01503
Total number of active participants reported on line 7a of the Form 55002022-01-01400
Number of retired or separated participants receiving benefits2022-01-0141
Number of other retired or separated participants entitled to future benefits2022-01-01103
Total of all active and inactive participants2022-01-01544
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01544
Number of participants with account balances2022-01-01491
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0149
2021: DOOR SYSTEMS 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01417
Total number of active participants reported on line 7a of the Form 55002021-01-01333
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0184
Total of all active and inactive participants2021-01-01417
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-011
Total participants2021-01-01418
Number of participants with account balances2021-01-01389
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-0127
2020: DOOR SYSTEMS 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01433
Total number of active participants reported on line 7a of the Form 55002020-01-01330
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0171
Total of all active and inactive participants2020-01-01401
Total participants2020-01-01401
Number of participants with account balances2020-01-01372
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0130
2019: DOOR SYSTEMS 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01364
Total number of active participants reported on line 7a of the Form 55002019-01-01317
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0170
Total of all active and inactive participants2019-01-01387
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01387
Number of participants with account balances2019-01-01368
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-0132

Financial Data on DOOR SYSTEMS 401(K) PLAN

Measure Date Value
2022 : DOOR SYSTEMS 401(K) 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$0
Total income from all sources (including contributions)2022-12-31$-828,642
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$2,574,544
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$2,495,608
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$2,101,493
Value of total assets at end of year2022-12-31$15,690,387
Value of total assets at beginning of year2022-12-31$19,093,573
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$78,936
Total interest from all sources2022-12-31$26,493
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$5,000,000
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$1,420,496
Participant contributions at end of year2022-12-31$217,480
Participant contributions at beginning of year2022-12-31$221,198
Participant contributions at end of year2022-12-31$41,968
Participant contributions at beginning of year2022-12-31$21,408
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$223,694
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$920
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-3,403,186
Value of net assets at end of year (total assets less liabilities)2022-12-31$15,690,387
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$19,093,573
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$68,988
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$14,546,747
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$17,850,131
Interest on participant loans2022-12-31$11,453
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$188
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$9,347
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$9,347
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$15,040
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$837,028
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$980,267
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-2,956,628
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 contributions2022-12-31Yes
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$457,303
Employer contributions (assets) at end of year2022-12-31$46,056
Employer contributions (assets) at beginning of year2022-12-31$11,222
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$2,495,608
Contract administrator fees2022-12-31$9,948
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31PRICEKUBECKA, PLLC
Accountancy firm EIN2022-12-31752783674
2021 : DOOR SYSTEMS 401(K) PLAN 2021 401k financial data
Total income from all sources (including contributions)2021-12-31$3,902,595
Total of all expenses incurred2021-12-31$1,965,101
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,880,172
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,608,640
Value of total assets at end of year2021-12-31$19,093,573
Value of total assets at beginning of year2021-12-31$17,156,079
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$84,929
Total interest from all sources2021-12-31$25,338
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$5,000,000
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$1,260,113
Participant contributions at end of year2021-12-31$221,198
Participant contributions at beginning of year2021-12-31$211,809
Participant contributions at end of year2021-12-31$21,408
Participant contributions at beginning of year2021-12-31$8,224
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$47,647
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,937,494
Value of net assets at end of year (total assets less liabilities)2021-12-31$19,093,573
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$17,156,079
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$17,850,131
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$15,866,191
Interest on participant loans2021-12-31$10,856
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$9,347
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$9,253
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$9,253
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$14,482
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$980,267
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$933,295
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$2,268,617
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 contributions2021-12-31Yes
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$300,880
Employer contributions (assets) at end of year2021-12-31$11,222
Employer contributions (assets) at beginning of year2021-12-31$127,307
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,880,172
Contract administrator fees2021-12-31$84,929
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31PRICEKUBECKA, PLLC
Accountancy firm EIN2021-12-31752783674
2020 : DOOR SYSTEMS 401(K) PLAN 2020 401k financial data
Total income from all sources (including contributions)2020-12-31$3,740,761
Total of all expenses incurred2020-12-31$2,212,947
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$2,138,644
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$1,596,500
Value of total assets at end of year2020-12-31$17,156,079
Value of total assets at beginning of year2020-12-31$15,628,265
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$74,303
Total interest from all sources2020-12-31$22,555
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$5,000,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$1,263,732
Participant contributions at end of year2020-12-31$211,809
Participant contributions at beginning of year2020-12-31$188,867
Participant contributions at end of year2020-12-31$8,224
Participant contributions at beginning of year2020-12-31$4,722
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$22,928
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$1,527,814
Value of net assets at end of year (total assets less liabilities)2020-12-31$17,156,079
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$15,628,265
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$74,303
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$15,866,191
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$15,389,177
Interest on participant loans2020-12-31$10,946
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$9,253
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$4,406
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$4,406
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$11,609
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$933,295
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$32,130
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$2,121,706
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 contributions2020-12-31Yes
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$309,840
Employer contributions (assets) at end of year2020-12-31$127,307
Employer contributions (assets) at beginning of year2020-12-31$8,963
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$2,138,644
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 plan2020-12-31Unqualified
Accountancy firm name2020-12-31PRICEKUBECKA, PLLC
Accountancy firm EIN2020-12-31752783674
2019 : DOOR SYSTEMS 401(K) PLAN 2019 401k financial data
Total transfer of assets to this plan2019-12-31$3,794,320
Total income from all sources (including contributions)2019-12-31$4,421,087
Total of all expenses incurred2019-12-31$871,293
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$813,095
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$1,934,858
Value of total assets at end of year2019-12-31$15,628,265
Value of total assets at beginning of year2019-12-31$8,284,151
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$58,198
Total interest from all sources2019-12-31$11,636
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$350,681
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$350,681
Administrative expenses professional fees incurred2019-12-31$58,198
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$5,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$1,264,770
Participant contributions at end of year2019-12-31$188,867
Participant contributions at beginning of year2019-12-31$92,331
Participant contributions at end of year2019-12-31$4,722
Participant contributions at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$222,609
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$3,549,794
Value of net assets at end of year (total assets less liabilities)2019-12-31$15,628,265
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$8,284,151
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$15,389,177
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$8,169,287
Interest on participant loans2019-12-31$10,960
Income. Interest from loans (other than to participants)2019-12-31$0
Interest earned on other investments2019-12-31$676
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$4,406
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$7,866
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$7,866
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$32,130
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$14,667
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$2,123,912
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$447,479
Employer contributions (assets) at end of year2019-12-31$8,963
Employer contributions (assets) at beginning of year2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$813,095
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31PRICEKUBECKA, PLLC
Accountancy firm EIN2019-12-31752783674

Form 5500 Responses for DOOR SYSTEMS 401(K) PLAN

2022: DOOR SYSTEMS 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 – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: DOOR SYSTEMS 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 – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: DOOR SYSTEMS 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 – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: DOOR SYSTEMS 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 – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-JU1M
Policy instance 1
Insurance contract or identification numberGAP-CP-JU1M
Number of Individuals Covered491
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,177
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,177
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerFINANCIAL SERVICES
Insurance broker organization code?4
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-JU1M
Policy instance 1
Insurance contract or identification numberGAP-CP-JU1M
Number of Individuals Covered389
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,216
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,216
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerFINANCIAL SERVICES
Insurance broker organization code?4
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-JU1M
Policy instance 1
Insurance contract or identification numberGAP-CP-JU1M
Number of Individuals Covered372
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,490
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,490
Additional information about fees paid to insurance brokerFINANCIAL SERVICES
Insurance broker organization code?4
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-JU1M
Policy instance 1
Insurance contract or identification numberGAP-CP-JU1M
Number of Individuals Covered368
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $74
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $74
Insurance broker organization code?4

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