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KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 401k Plan overview

Plan NameKAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN
Plan identification number 001

KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN Benefits

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

401k Sponsoring company profile

KAUKAUNA CLINIC, S.C. has sponsored the creation of one or more 401k plans.

Company Name:KAUKAUNA CLINIC, S.C.
Employer identification number (EIN):391189707
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01PAUL RUSSO2023-09-07
0012021-01-01GREGORY JOHNSON2022-10-12
0012020-01-01PAUL RUSSO, MD2021-09-10
0012019-01-01JENNIFER L SCHOENING2020-09-28
0012018-01-01
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01BRUCE DANZ
0012013-01-01GREGORY JOHNSON
0012012-01-01PAUL RUSSO
0012011-01-01PAUL RUSSO
0012010-01-01PAUL RUSSO
0012009-01-01BRUCE R DANZ

Plan Statistics for KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN

401k plan membership statisitcs for KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN

Measure Date Value
2022: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0174
Total number of active participants reported on line 7a of the Form 55002022-01-0128
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0143
Total of all active and inactive participants2022-01-0171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-0171
Number of participants with account balances2022-01-0171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0171
Total number of active participants reported on line 7a of the Form 55002021-01-0135
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0136
Total of all active and inactive participants2021-01-0171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0171
Number of participants with account balances2021-01-0171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0171
Total number of active participants reported on line 7a of the Form 55002020-01-0140
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0129
Total of all active and inactive participants2020-01-0169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0169
Number of participants with account balances2020-01-0169
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0170
Total number of active participants reported on line 7a of the Form 55002019-01-0146
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0123
Total of all active and inactive participants2019-01-0169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-0169
Number of participants with account balances2019-01-0169
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0170
Total number of active participants reported on line 7a of the Form 55002018-01-0154
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0114
Total of all active and inactive participants2018-01-0168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0168
Number of participants with account balances2018-01-0168
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0160
Total number of active participants reported on line 7a of the Form 55002017-01-0160
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0110
Total of all active and inactive participants2017-01-0170
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0170
Number of participants with account balances2017-01-0170
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0163
Total number of active participants reported on line 7a of the Form 55002016-01-0151
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-019
Total of all active and inactive participants2016-01-0160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0160
Number of participants with account balances2016-01-0160
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0164
Total number of active participants reported on line 7a of the Form 55002015-01-0152
Number of retired or separated participants receiving benefits2015-01-013
Number of other retired or separated participants entitled to future benefits2015-01-016
Total of all active and inactive participants2015-01-0161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0161
Number of participants with account balances2015-01-0161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0164
Total number of active participants reported on line 7a of the Form 55002014-01-0155
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-018
Total of all active and inactive participants2014-01-0163
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0163
Number of participants with account balances2014-01-0163
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0165
Total number of active participants reported on line 7a of the Form 55002013-01-0153
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-018
Total of all active and inactive participants2013-01-0161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0161
Number of participants with account balances2013-01-0161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0168
Total number of active participants reported on line 7a of the Form 55002012-01-0156
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-019
Total of all active and inactive participants2012-01-0165
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0165
Number of participants with account balances2012-01-0165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0167
Total number of active participants reported on line 7a of the Form 55002011-01-0156
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0110
Total of all active and inactive participants2011-01-0166
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0166
Number of participants with account balances2011-01-0166
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0165
Total number of active participants reported on line 7a of the Form 55002010-01-0154
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-017
Total of all active and inactive participants2010-01-0161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0161
Number of participants with account balances2010-01-0161
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0162
Total number of active participants reported on line 7a of the Form 55002009-01-0152
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0110
Total of all active and inactive participants2009-01-0162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0162
Number of participants with account balances2009-01-0162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN

Measure Date Value
2022 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2022 401k financial data
Total income from all sources2022-12-31$-2,659,768
Expenses. Total of all expenses incurred2022-12-31$1,323,427
Benefits paid (including direct rollovers)2022-12-31$1,323,027
Total plan assets at end of year2022-12-31$16,504,763
Total plan assets at beginning of year2022-12-31$20,487,958
Value of fidelity bond covering the plan2022-12-31$600,000
Total contributions received or receivable from participants2022-12-31$304,815
Other income received2022-12-31$-3,253,463
Net income (gross income less expenses)2022-12-31$-3,983,195
Net plan assets at end of year (total assets less liabilities)2022-12-31$16,504,763
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$20,487,958
Assets. Value of assets in partnership/joint-venture interests2022-12-31$330,630
Total contributions received or receivable from employer(s)2022-12-31$288,880
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$400
2021 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2021 401k financial data
Total income from all sources2021-12-31$2,970,093
Expenses. Total of all expenses incurred2021-12-31$4,471,337
Benefits paid (including direct rollovers)2021-12-31$4,470,737
Total plan assets at end of year2021-12-31$20,487,958
Total plan assets at beginning of year2021-12-31$21,989,202
Value of fidelity bond covering the plan2021-12-31$600,000
Total contributions received or receivable from participants2021-12-31$299,248
Other income received2021-12-31$2,367,697
Net income (gross income less expenses)2021-12-31$-1,501,244
Net plan assets at end of year (total assets less liabilities)2021-12-31$20,487,958
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$21,989,202
Assets. Value of assets in partnership/joint-venture interests2021-12-31$321,036
Total contributions received or receivable from employer(s)2021-12-31$303,148
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$600
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
2020 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2020 401k financial data
Total income from all sources2020-12-31$3,526,091
Expenses. Total of all expenses incurred2020-12-31$1,302,399
Benefits paid (including direct rollovers)2020-12-31$1,301,949
Total plan assets at end of year2020-12-31$21,989,202
Total plan assets at beginning of year2020-12-31$19,765,510
Value of fidelity bond covering the plan2020-12-31$600,000
Total contributions received or receivable from participants2020-12-31$331,080
Other income received2020-12-31$2,809,660
Net income (gross income less expenses)2020-12-31$2,223,692
Net plan assets at end of year (total assets less liabilities)2020-12-31$21,989,202
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$19,765,510
Assets. Value of assets in partnership/joint-venture interests2020-12-31$306,670
Total contributions received or receivable from employer(s)2020-12-31$385,351
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$450
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
2019 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2019 401k financial data
Total income from all sources2019-12-31$4,147,088
Expenses. Total of all expenses incurred2019-12-31$1,451,885
Benefits paid (including direct rollovers)2019-12-31$1,451,235
Total plan assets at end of year2019-12-31$19,765,510
Total plan assets at beginning of year2019-12-31$17,070,307
Value of fidelity bond covering the plan2019-12-31$600,000
Total contributions received or receivable from participants2019-12-31$355,747
Other income received2019-12-31$3,446,354
Net income (gross income less expenses)2019-12-31$2,695,203
Net plan assets at end of year (total assets less liabilities)2019-12-31$19,765,510
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$17,070,307
Assets. Value of participant loans2019-12-31$0
Assets. Value of assets in partnership/joint-venture interests2019-12-31$306,447
Total contributions received or receivable from employer(s)2019-12-31$344,987
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$650
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
2018 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2018 401k financial data
Total income from all sources2018-12-31$-502,563
Expenses. Total of all expenses incurred2018-12-31$732,097
Benefits paid (including direct rollovers)2018-12-31$731,572
Total plan assets at end of year2018-12-31$17,070,307
Total plan assets at beginning of year2018-12-31$18,304,967
Value of fidelity bond covering the plan2018-12-31$600,000
Total contributions received or receivable from participants2018-12-31$361,111
Other income received2018-12-31$-1,304,215
Net income (gross income less expenses)2018-12-31$-1,234,660
Net plan assets at end of year (total assets less liabilities)2018-12-31$17,070,307
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$18,304,967
Assets. Value of participant loans2018-12-31$5,002
Assets. Value of assets in partnership/joint-venture interests2018-12-31$412,436
Total contributions received or receivable from employer(s)2018-12-31$440,541
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$525
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2017 401k financial data
Total income from all sources2017-12-31$3,117,612
Expenses. Total of all expenses incurred2017-12-31$84,587
Benefits paid (including direct rollovers)2017-12-31$84,262
Total plan assets at end of year2017-12-31$18,304,967
Total plan assets at beginning of year2017-12-31$15,271,942
Value of fidelity bond covering the plan2017-12-31$600,000
Total contributions received or receivable from participants2017-12-31$372,702
Other income received2017-12-31$2,301,079
Net income (gross income less expenses)2017-12-31$3,033,025
Net plan assets at end of year (total assets less liabilities)2017-12-31$18,304,967
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$15,271,942
Assets. Value of participant loans2017-12-31$19,710
Assets. Value of assets in partnership/joint-venture interests2017-12-31$568,947
Total contributions received or receivable from employer(s)2017-12-31$443,831
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$325
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2016 401k financial data
Total income from all sources2016-12-31$1,706,091
Expenses. Total of all expenses incurred2016-12-31$821,044
Benefits paid (including direct rollovers)2016-12-31$820,494
Total plan assets at end of year2016-12-31$15,271,942
Total plan assets at beginning of year2016-12-31$14,386,895
Value of fidelity bond covering the plan2016-12-31$600,000
Total contributions received or receivable from participants2016-12-31$350,511
Contributions received from other sources (not participants or employers)2016-12-31$52,684
Other income received2016-12-31$881,781
Noncash contributions received2016-12-31$0
Net income (gross income less expenses)2016-12-31$885,047
Net plan assets at end of year (total assets less liabilities)2016-12-31$15,271,942
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$14,386,895
Assets. Value of participant loans2016-12-31$40,215
Assets. Value of assets in partnership/joint-venture interests2016-12-31$542,626
Total contributions received or receivable from employer(s)2016-12-31$421,115
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$550
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2015 401k financial data
Total income from all sources2015-12-31$690,050
Expenses. Total of all expenses incurred2015-12-31$920,219
Benefits paid (including direct rollovers)2015-12-31$914,392
Total plan assets at end of year2015-12-31$14,386,895
Total plan assets at beginning of year2015-12-31$14,617,064
Value of fidelity bond covering the plan2015-12-31$600,000
Total contributions received or receivable from participants2015-12-31$381,955
Other income received2015-12-31$-134,798
Net income (gross income less expenses)2015-12-31$-230,169
Net plan assets at end of year (total assets less liabilities)2015-12-31$14,386,895
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$14,617,064
Assets. Value of participant loans2015-12-31$45,425
Assets. Value of assets in partnership/joint-venture interests2015-12-31$555,580
Total contributions received or receivable from employer(s)2015-12-31$442,893
Value of certain deemed distributions of participant loans2015-12-31$5,252
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$575
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2014 401k financial data
Total income from all sources2014-12-31$1,284,208
Expenses. Total of all expenses incurred2014-12-31$206,196
Benefits paid (including direct rollovers)2014-12-31$205,809
Total plan assets at end of year2014-12-31$14,617,064
Total plan assets at beginning of year2014-12-31$13,539,052
Value of fidelity bond covering the plan2014-12-31$600,000
Total contributions received or receivable from participants2014-12-31$365,839
Other income received2014-12-31$460,164
Net income (gross income less expenses)2014-12-31$1,078,012
Net plan assets at end of year (total assets less liabilities)2014-12-31$14,617,064
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$13,539,052
Assets. Value of participant loans2014-12-31$51,550
Assets. Value of assets in partnership/joint-venture interests2014-12-31$527,761
Total contributions received or receivable from employer(s)2014-12-31$458,205
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$387
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2013 401k financial data
Total income from all sources2013-12-31$2,435,555
Expenses. Total of all expenses incurred2013-12-31$1,524,095
Benefits paid (including direct rollovers)2013-12-31$1,523,370
Total plan assets at end of year2013-12-31$13,539,052
Total plan assets at beginning of year2013-12-31$12,627,592
Value of fidelity bond covering the plan2013-12-31$500,000
Total contributions received or receivable from participants2013-12-31$356,133
Expenses. Other expenses not covered elsewhere2013-12-31$725
Contributions received from other sources (not participants or employers)2013-12-31$138,633
Other income received2013-12-31$1,532,962
Net income (gross income less expenses)2013-12-31$911,460
Net plan assets at end of year (total assets less liabilities)2013-12-31$13,539,052
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$12,627,592
Assets. Value of participant loans2013-12-31$70,522
Assets. Value of assets in partnership/joint-venture interests2013-12-31$500,715
Total contributions received or receivable from employer(s)2013-12-31$407,827
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2012 401k financial data
Total income from all sources2012-12-31$2,237,458
Expenses. Total of all expenses incurred2012-12-31$91,836
Benefits paid (including direct rollovers)2012-12-31$91,598
Total plan assets at end of year2012-12-31$12,627,592
Total plan assets at beginning of year2012-12-31$10,481,970
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$367,417
Other income received2012-12-31$1,425,884
Net income (gross income less expenses)2012-12-31$2,145,622
Net plan assets at end of year (total assets less liabilities)2012-12-31$12,627,592
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$10,481,970
Assets. Value of participant loans2012-12-31$31,789
Assets. Value of assets in partnership/joint-venture interests2012-12-31$419,213
Total contributions received or receivable from employer(s)2012-12-31$444,157
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$238
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2011 401k financial data
Total income from all sources2011-12-31$574,963
Expenses. Total of all expenses incurred2011-12-31$350,457
Benefits paid (including direct rollovers)2011-12-31$350,457
Total plan assets at end of year2011-12-31$10,481,970
Total plan assets at beginning of year2011-12-31$10,257,464
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$347,529
Contributions received from other sources (not participants or employers)2011-12-31$34,278
Other income received2011-12-31$-213,355
Net income (gross income less expenses)2011-12-31$224,506
Net plan assets at end of year (total assets less liabilities)2011-12-31$10,481,970
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$10,257,464
Assets. Value of participant loans2011-12-31$21,610
Assets. Value of assets in partnership/joint-venture interests2011-12-31$404,280
Total contributions received or receivable from employer(s)2011-12-31$406,511
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2010 401k financial data
Total income from all sources2010-12-31$1,906,408
Expenses. Total of all expenses incurred2010-12-31$242,476
Benefits paid (including direct rollovers)2010-12-31$242,264
Total plan assets at end of year2010-12-31$10,257,464
Total plan assets at beginning of year2010-12-31$8,593,532
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$328,732
Other income received2010-12-31$1,189,975
Net income (gross income less expenses)2010-12-31$1,663,932
Net plan assets at end of year (total assets less liabilities)2010-12-31$10,257,464
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$8,593,532
Assets. Value of participant loans2010-12-31$41,943
Assets. Value of assets in partnership/joint-venture interests2010-12-31$378,999
Total contributions received or receivable from employer(s)2010-12-31$387,701
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$212
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN

2022: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS 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: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS 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: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS 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: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS 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
2018: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
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 – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: KAUKAUNA CLINIC, S.C. 401(K) AND RETIREMENT SAVINGS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered11
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,875
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $2,875
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered13
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,327
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $3,327
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered15
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,522
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $3,522
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered15
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,184
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $4,184
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered17
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $8,348
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $8,348
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered20
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $6,915
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $6,915
Insurance broker organization code?3
Insurance broker nameROBERT W BAIRD & CO
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered61
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $9,167
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $9,167
Insurance broker organization code?3
Insurance broker nameROBERT W BAIRD & CO
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered17
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $7,451
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $7,451
Insurance broker organization code?3
Insurance broker nameROBERT W BAIRD & CO
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered61
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $8,163
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $8,163
Insurance broker organization code?3
Insurance broker nameROBERT W BAIRD & CO
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered65
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,257
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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 $9,257
Insurance broker organization code?3
Insurance broker nameROBERT W BAIRD & CO
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered66
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $185
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number384594-01
Policy instance 1
Insurance contract or identification number384594-01
Number of Individuals Covered61
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $115
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
Commission paid to Insurance BrokerUSD $115
Insurance broker organization code?3
Insurance broker nameROBERT W BAIRD & CO

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