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FOGO DE CHAO (HOLDINGS) INC. 401k Plan overview

Plan NameFOGO DE CHAO (HOLDINGS) INC.
Plan identification number 001

FOGO DE CHAO (HOLDINGS) INC. 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.
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

FOGO DE CHAO, INC. has sponsored the creation of one or more 401k plans.

Company Name:FOGO DE CHAO, INC.
Employer identification number (EIN):371696581
NAIC Classification:722511
NAIC Description:Full-Service Restaurants

Additional information about FOGO DE CHAO, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2018-03-29
Company Identification Number: 0802977264
Legal Registered Office Address: 1999 BRYAN ST STE 900

DALLAS
United States of America (USA)
75201

More information about FOGO DE CHAO, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOGO DE CHAO (HOLDINGS) INC.

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
0012018-01-01
0012017-01-01LANCE KESTERSON
0012016-10-01NANCY CASSENS
0012016-01-01LANCE KESTERSON

Plan Statistics for FOGO DE CHAO (HOLDINGS) INC.

401k plan membership statisitcs for FOGO DE CHAO (HOLDINGS) INC.

Measure Date Value
2022: FOGO DE CHAO (HOLDINGS) INC. 2022 401k membership
Total participants, beginning-of-year2022-01-011,756
Total number of active participants reported on line 7a of the Form 55002022-01-011,964
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0138
Total of all active and inactive participants2022-01-012,002
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-012,002
Number of participants with account balances2022-01-01379
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: FOGO DE CHAO (HOLDINGS) INC. 2021 401k membership
Total participants, beginning-of-year2021-01-011,867
Total number of active participants reported on line 7a of the Form 55002021-01-011,465
Number of retired or separated participants receiving benefits2021-01-01127
Number of other retired or separated participants entitled to future benefits2021-01-011,592
Total of all active and inactive participants2021-01-013,184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-013,184
Number of participants with account balances2021-01-01456
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: FOGO DE CHAO (HOLDINGS) INC. 2020 401k membership
Total participants, beginning-of-year2020-01-011,879
Total number of active participants reported on line 7a of the Form 55002020-01-011,396
Number of retired or separated participants receiving benefits2020-01-012
Number of other retired or separated participants entitled to future benefits2020-01-01139
Total of all active and inactive participants2020-01-011,537
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-011,537
Number of participants with account balances2020-01-01423
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: FOGO DE CHAO (HOLDINGS) INC. 2019 401k membership
Total participants, beginning-of-year2019-01-012,225
Total number of active participants reported on line 7a of the Form 55002019-01-011,552
Number of retired or separated participants receiving benefits2019-01-012
Number of other retired or separated participants entitled to future benefits2019-01-0188
Total of all active and inactive participants2019-01-011,642
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-011,642
Number of participants with account balances2019-01-01411
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-011
2018: FOGO DE CHAO (HOLDINGS) INC. 2018 401k membership
Total participants, beginning-of-year2018-01-012,083
Total number of active participants reported on line 7a of the Form 55002018-01-011,674
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-01106
Total of all active and inactive participants2018-01-011,780
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-011,780
Number of participants with account balances2018-01-01395
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: FOGO DE CHAO (HOLDINGS) INC. 2017 401k membership
Total participants, beginning-of-year2017-01-011,664
Total number of active participants reported on line 7a of the Form 55002017-01-011,436
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-01149
Total of all active and inactive participants2017-01-011,585
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-011,585
Number of participants with account balances2017-01-01538
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: FOGO DE CHAO (HOLDINGS) INC. 2016 401k membership
Total participants, beginning-of-year2016-10-011,120
Total number of active participants reported on line 7a of the Form 55002016-10-011,238
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-011,238
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-10-010
Total participants2016-10-011,238
Number of participants with account balances2016-10-01164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-10-010
Total participants, beginning-of-year2016-01-011,120
Total number of active participants reported on line 7a of the Form 55002016-01-011,238
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-011,238
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-011,238
Number of participants with account balances2016-01-01164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010

Financial Data on FOGO DE CHAO (HOLDINGS) INC.

Measure Date Value
2022 : FOGO DE CHAO (HOLDINGS) INC. 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$629,536
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$413,071
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$385,989
Expenses. Certain deemed distributions of participant loans2022-12-31$1,791
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,113,616
Value of total assets at end of year2022-12-31$2,919,298
Value of total assets at beginning of year2022-12-31$2,702,833
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$25,291
Total interest from all sources2022-12-31$2,403
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$2,730
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$2,730
Was this plan covered by a fidelity bond2022-12-31No
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$640,594
Participant contributions at end of year2022-12-31$73,381
Participant contributions at beginning of year2022-12-31$38,469
Participant contributions at beginning of year2022-12-31$713
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$473,022
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-12-31$742
Other income not declared elsewhere2022-12-31$3,570
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$216,465
Value of net assets at end of year (total assets less liabilities)2022-12-31$2,919,298
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$2,702,833
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$182,522
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$2,657,611
Interest on participant loans2022-12-31$2,403
Value of interest in common/collective trusts at end of year2022-12-31$2,663,395
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$6,040
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-27,408
Net investment gain or loss from common/collective trusts2022-12-31$-465,375
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$385,247
Contract administrator fees2022-12-31$25,291
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 name2022-12-31PW PARTNERS, LLC
Accountancy firm EIN2022-12-31833323563
2021 : FOGO DE CHAO (HOLDINGS) INC. 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$36,119
Total income from all sources (including contributions)2021-12-31$887,556
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$126,314
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$55,499
Value of total corrective distributions2021-12-31$36,119
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$568,288
Value of total assets at end of year2021-12-31$2,702,833
Value of total assets at beginning of year2021-12-31$1,977,710
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$34,696
Total interest from all sources2021-12-31$1,752
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$200,000
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$567,193
Participant contributions at end of year2021-12-31$38,469
Participant contributions at beginning of year2021-12-31$24,281
Participant contributions at end of year2021-12-31$713
Participant contributions at beginning of year2021-12-31$996
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$1,095
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$36,119
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$761,242
Value of net assets at end of year (total assets less liabilities)2021-12-31$2,702,833
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,941,591
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$34,696
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$2,657,611
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$1,949,704
Interest on participant loans2021-12-31$1,752
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$6,040
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$2,729
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$317,516
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$55,499
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 name2021-12-31PW PARTNERS LLC
Accountancy firm EIN2021-12-31833323563
2020 : FOGO DE CHAO (HOLDINGS) INC. 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$36,119
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$29,533
Total income from all sources (including contributions)2020-12-31$664,667
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$319,076
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$286,258
Expenses. Certain deemed distributions of participant loans2020-12-31$5,345
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$460,501
Value of total assets at end of year2020-12-31$1,977,710
Value of total assets at beginning of year2020-12-31$1,625,533
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$27,473
Total interest from all sources2020-12-31$1,366
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$162,553
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$460,501
Participant contributions at end of year2020-12-31$24,281
Participant contributions at beginning of year2020-12-31$17,298
Participant contributions at end of year2020-12-31$996
Participant contributions at beginning of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$90
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$36,119
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$29,533
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$345,591
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,941,591
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$1,596,000
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$8,022
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$1,949,704
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$1,606,742
Interest on participant loans2020-12-31$1,366
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$2,729
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$1,403
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$202,800
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$286,258
Contract administrator fees2020-12-31$19,451
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 name2020-12-31PW PARTNERS LLC
Accountancy firm EIN2020-12-31833323563
2019 : FOGO DE CHAO (HOLDINGS) INC. 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$29,533
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$29,533
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$18,849
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$18,849
Total income from all sources (including contributions)2019-12-31$723,924
Total income from all sources (including contributions)2019-12-31$723,924
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$184,559
Total of all expenses incurred2019-12-31$184,559
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$160,548
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$160,548
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$492,069
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$492,069
Value of total assets at end of year2019-12-31$1,625,533
Value of total assets at end of year2019-12-31$1,625,533
Value of total assets at beginning of year2019-12-31$1,075,484
Value of total assets at beginning of year2019-12-31$1,075,484
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$24,011
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$24,011
Total interest from all sources2019-12-31$971
Total interest from all sources2019-12-31$971
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$20
Administrative expenses professional fees incurred2019-12-31$20
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$105,664
Value of fidelity bond cover2019-12-31$105,664
If this is an individual account plan, was there a blackout period2019-12-31No
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
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$489,026
Contributions received from participants2019-12-31$489,026
Participant contributions at end of year2019-12-31$17,298
Participant contributions at end of year2019-12-31$17,298
Participant contributions at beginning of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Participant contributions at end of year2019-12-31$0
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$15,542
Participant contributions at beginning of year2019-12-31$15,542
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$3,043
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$3,043
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$90
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$90
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$29,533
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$29,533
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$18,849
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$18,849
Other income not declared elsewhere2019-12-31$90
Other income not declared elsewhere2019-12-31$90
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
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$539,365
Value of net income/loss2019-12-31$539,365
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,596,000
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,596,000
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,056,635
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,056,635
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
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 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
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$23,991
Investment advisory and management fees2019-12-31$23,991
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$1,606,742
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$1,606,742
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$1,058,855
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$1,058,855
Interest on participant loans2019-12-31$971
Interest on participant loans2019-12-31$971
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$1,403
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$1,403
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$1,087
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$1,087
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$230,794
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$230,794
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
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
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
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$160,548
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$160,548
Did the plan have assets held for investment2019-12-31Yes
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
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
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
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
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31PW PARTNERS LLC
Accountancy firm name2019-12-31PW PARTNERS LLC
Accountancy firm EIN2019-12-31833323563
Accountancy firm EIN2019-12-31833323563
2018 : FOGO DE CHAO (HOLDINGS) INC. 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$18,849
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$3,692
Total income from all sources (including contributions)2018-12-31$399,357
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$220,813
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$197,304
Expenses. Certain deemed distributions of participant loans2018-12-31$3,692
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$471,109
Value of total assets at end of year2018-12-31$1,075,484
Value of total assets at beginning of year2018-12-31$881,783
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$19,817
Total interest from all sources2018-12-31$111
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$21
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$105,994
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$471,109
Participant contributions at end of year2018-12-31$15,542
Participant contributions at beginning of year2018-12-31$41,683
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$18,849
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$3,692
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$178,544
Value of net assets at end of year (total assets less liabilities)2018-12-31$1,056,635
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$878,091
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$19,796
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$1,058,855
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$829,909
Interest earned on other investments2018-12-31$90
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$21
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$1,087
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-71,863
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Employer contributions (assets) at end of year2018-12-31$0
Employer contributions (assets) at beginning of year2018-12-31$10,191
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$197,304
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31PW PARTNERS LLC
Accountancy firm EIN2018-12-31833323563
2017 : FOGO DE CHAO (HOLDINGS) INC. 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$3,692
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$674,984
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$93,992
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$30,026
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$524,672
Value of total assets at end of year2017-12-31$881,783
Value of total assets at beginning of year2017-12-31$297,099
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$63,966
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31No
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$516,989
Participant contributions at end of year2017-12-31$41,683
Participant contributions at beginning of year2017-12-31$17,634
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$3,692
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$580,992
Value of net assets at end of year (total assets less liabilities)2017-12-31$878,091
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$297,099
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$829,909
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$276,957
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$150,312
Net investment gain/loss from pooled separate accounts2017-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$7,683
Employer contributions (assets) at end of year2017-12-31$10,191
Employer contributions (assets) at beginning of year2017-12-31$2,508
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$30,026
Contract administrator fees2017-12-31$63,966
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31CLARUS PARTNERS
Accountancy firm EIN2017-12-31261347383
Total unrealized appreciation/depreciation of assets2017-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$0
Total income from all sources (including contributions)2017-09-30$295,229
Total loss/gain on sale of assets2017-09-30$0
Total of all expenses incurred2017-09-30$638
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-09-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-09-30$290,561
Value of total assets at end of year2017-09-30$294,591
Value of total assets at beginning of year2017-09-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-09-30$638
Total interest from all sources2017-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2017-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-09-30No
Was this plan covered by a fidelity bond2017-09-30No
If this is an individual account plan, was there a blackout period2017-09-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-09-30$0
Were there any nonexempt tranactions with any party-in-interest2017-09-30No
Contributions received from participants2017-09-30$274,624
Income. Received or receivable in cash from other sources (including rollovers)2017-09-30$15,937
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Value of net income/loss2017-09-30$294,591
Value of net assets at end of year (total assets less liabilities)2017-09-30$294,591
Value of net assets at beginning of year (total assets less liabilities)2017-09-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-09-30No
Were any leases to which the plan was party in default or uncollectible2017-09-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-09-30$294,591
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-09-30$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-09-30$4,668
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-09-30No
Was there a failure to transmit to the plan any participant contributions2017-09-30No
Has the plan failed to provide any benefit when due under the plan2017-09-30No
Contract administrator fees2017-09-30$638
Did the plan have assets held for investment2017-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-09-30Yes
Opinion of an independent qualified public accountant for this plan2017-09-30Disclaimer
Accountancy firm name2017-09-30N/A
Accountancy firm EIN2017-09-30010101010
2016 : FOGO DE CHAO (HOLDINGS) INC. 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$297,863
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$764
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$293,069
Value of total assets at end of year2016-12-31$297,099
Value of total assets at beginning of year2016-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$764
Total interest from all sources2016-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$764
Was this plan covered by a fidelity bond2016-12-31No
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$274,624
Participant contributions at end of year2016-12-31$17,634
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$15,937
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$297,099
Value of net assets at end of year (total assets less liabilities)2016-12-31$297,099
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$276,957
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$4,794
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$2,508
Employer contributions (assets) at end of year2016-12-31$2,508
Contract administrator fees2016-12-31$0
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31CLARUS PARTNERS
Accountancy firm EIN2016-12-31261347383

Form 5500 Responses for FOGO DE CHAO (HOLDINGS) INC.

2022: FOGO DE CHAO (HOLDINGS) INC. 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
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: FOGO DE CHAO (HOLDINGS) INC. 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 – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: FOGO DE CHAO (HOLDINGS) INC. 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 – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: FOGO DE CHAO (HOLDINGS) INC. 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 – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: FOGO DE CHAO (HOLDINGS) INC. 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 – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: FOGO DE CHAO (HOLDINGS) INC. 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 – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: FOGO DE CHAO (HOLDINGS) INC. 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01First time form 5500 has been submittedYes
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
2016-01-01Submission has been amendedYes
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number472980
Policy instance 1
Insurance contract or identification number472980
Number of Individuals Covered2002
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
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 numberGAP-CP-JD0R
Policy instance 1
Insurance contract or identification numberGAP-CP-JD0R
Number of Individuals Covered7
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $22
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 $22
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-JD0R
Policy instance 1
Insurance contract or identification numberGAP-CP-JD0R
Number of Individuals Covered3
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $6
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 BenefitYes
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 $6
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-JD0R
Policy instance 1
Insurance contract or identification numberGAP-CP-JD0R
Number of Individuals Covered411
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 BenefitYes
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 numberGAP-CP-JD0R
Policy instance 1
Insurance contract or identification numberGAP-CP-JD0R
Number of Individuals Covered395
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 BenefitYes
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 numberGAP-CP-JD0R
Policy instance 1
Insurance contract or identification numberGAP-CP-JD0R
Number of Individuals Covered538
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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