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WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameWORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN
Plan identification number 001

WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN Benefits

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

MOTORCYCLE CITY, INC. DBA WORTH HARLEY DAVIDSON has sponsored the creation of one or more 401k plans.

Company Name:MOTORCYCLE CITY, INC. DBA WORTH HARLEY DAVIDSON
Employer identification number (EIN):431132283
NAIC Classification:441228
NAIC Description:Motorcycle, ATV, and All Other Motor Vehicle Dealers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012018-01-01
0012017-01-01RICHARD D. WORTH2018-06-18
0012016-01-01RICHARD D. WORTH2017-06-19
0012015-01-01RICHARD D. WORTH2016-08-19
0012014-01-01RICHARD D. WORTH2015-07-21
0012013-01-01RICHARD D. WORTH2014-08-15
0012012-01-01RICHARD D. WORTH2013-09-05
0012011-01-01RICHARD D. WORTH2012-10-02 RICHARD D. WORTH2012-10-02
0012010-01-01RICHARD D. WORTH2011-09-09 RICHARD D. WORTH2011-09-09

Plan Statistics for WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN

Measure Date Value
2022: WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01124
Total number of active participants reported on line 7a of the Form 55002022-01-01108
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0113
Total of all active and inactive participants2022-01-01121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01121
Number of participants with account balances2022-01-0199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-012
2021: WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01121
Total number of active participants reported on line 7a of the Form 55002021-01-01114
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0112
Total of all active and inactive participants2021-01-01126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01126
Number of participants with account balances2021-01-0198
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-011
2020: WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01146
Total number of active participants reported on line 7a of the Form 55002020-01-01106
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0114
Total of all active and inactive participants2020-01-01120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01120
Number of participants with account balances2020-01-0187
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-012
2019: WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01162
Total number of active participants reported on line 7a of the Form 55002019-01-01128
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0115
Total of all active and inactive participants2019-01-01143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01143
Number of participants with account balances2019-01-0186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01162
Total number of active participants reported on line 7a of the Form 55002018-01-01129
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0135
Total of all active and inactive participants2018-01-01164
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01164
Number of participants with account balances2018-01-01102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-0158

Financial Data on WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN

Measure Date Value
2022 : WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-621,879
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$304,693
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$248,726
Value of total corrective distributions2022-12-31$13,600
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$486,047
Value of total assets at end of year2022-12-31$6,180,711
Value of total assets at beginning of year2022-12-31$7,107,283
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$42,367
Total interest from all sources2022-12-31$9,406
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$45,856
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$45,856
Administrative expenses professional fees incurred2022-12-31$9,095
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$422,162
Participant contributions at end of year2022-12-31$133,099
Participant contributions at beginning of year2022-12-31$114,947
Participant contributions at beginning of year2022-12-31$1,631
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-926,572
Value of net assets at end of year (total assets less liabilities)2022-12-31$6,180,711
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$7,107,283
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$2,004,788
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$2,343,665
Value of interest in pooled separate accounts at end of year2022-12-31$488,514
Value of interest in pooled separate accounts at beginning of year2022-12-31$583,641
Interest on participant loans2022-12-31$5,700
Interest earned on other investments2022-12-31$3,706
Value of interest in common/collective trusts at end of year2022-12-31$3,266,024
Value of interest in common/collective trusts at beginning of year2022-12-31$3,658,130
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$224,401
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$340,133
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-441,176
Net investment gain/loss from pooled separate accounts2022-12-31$-99,984
Net investment gain or loss from common/collective trusts2022-12-31$-622,028
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$63,885
Employer contributions (assets) at end of year2022-12-31$63,885
Employer contributions (assets) at beginning of year2022-12-31$65,136
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$248,726
Contract administrator fees2022-12-31$33,272
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 name2022-12-31SAMYN & MARTIN, LLC
Accountancy firm EIN2022-12-31431679261
2021 : WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$1,389,856
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$335,002
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$253,193
Value of total corrective distributions2021-12-31$30,267
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$586,528
Value of total assets at end of year2021-12-31$7,107,283
Value of total assets at beginning of year2021-12-31$6,052,429
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$51,542
Total interest from all sources2021-12-31$12,252
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$45,155
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$45,155
Administrative expenses professional fees incurred2021-12-31$8,749
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
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$452,904
Participant contributions at end of year2021-12-31$114,947
Participant contributions at beginning of year2021-12-31$115,133
Participant contributions at end of year2021-12-31$1,631
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$68,488
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,054,854
Value of net assets at end of year (total assets less liabilities)2021-12-31$7,107,283
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$6,052,429
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$2,343,665
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$1,984,144
Value of interest in pooled separate accounts at end of year2021-12-31$583,641
Value of interest in pooled separate accounts at beginning of year2021-12-31$463,782
Interest on participant loans2021-12-31$7,190
Interest earned on other investments2021-12-31$5,062
Value of interest in common/collective trusts at end of year2021-12-31$3,658,130
Value of interest in common/collective trusts at beginning of year2021-12-31$3,119,956
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$340,133
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$306,585
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$190,406
Net investment gain/loss from pooled separate accounts2021-12-31$112,013
Net investment gain or loss from common/collective trusts2021-12-31$443,502
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
Contributions received in cash from employer2021-12-31$65,136
Employer contributions (assets) at end of year2021-12-31$65,136
Employer contributions (assets) at beginning of year2021-12-31$62,829
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$253,193
Contract administrator fees2021-12-31$42,793
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 name2021-12-31SAMYN & MARTIN, LLC
Accountancy firm EIN2021-12-31431679261
2020 : WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets2020-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$0
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total transfer of assets to this plan2020-12-31$37,436
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Expenses. Interest paid2020-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022020-12-31$0
Total income from all sources (including contributions)2020-12-31$1,187,840
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$256,968
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$203,077
Expenses. Certain deemed distributions of participant loans2020-12-31$0
Value of total corrective distributions2020-12-31$8,742
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$471,228
Value of total assets at end of year2020-12-31$6,052,429
Value of total assets at beginning of year2020-12-31$5,084,121
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$45,149
Total income from rents2020-12-31$0
Total interest from all sources2020-12-31$11,680
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$37,866
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$37,866
Administrative expenses professional fees incurred2020-12-31$8,499
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
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
Amount of non-exempt transactions with any party-in-interest2020-12-31$0
Contributions received from participants2020-12-31$401,523
Participant contributions at end of year2020-12-31$115,133
Participant contributions at beginning of year2020-12-31$119,380
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$6,876
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$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$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$0
Other income not declared elsewhere2020-12-31$0
Administrative expenses (other) incurred2020-12-31$0
Liabilities. Value of operating payables at beginning of year2020-12-31$0
Total non interest bearing cash at end of year2020-12-31$0
Total non interest bearing cash at beginning of year2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Income. Non cash contributions2020-12-31$0
Value of net income/loss2020-12-31$930,872
Value of net assets at end of year (total assets less liabilities)2020-12-31$6,052,429
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$5,084,121
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2020-12-31$0
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2020-12-31$0
Investment advisory and management fees2020-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$1,984,144
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$1,480,014
Value of interest in pooled separate accounts at end of year2020-12-31$463,782
Value of interest in pooled separate accounts at beginning of year2020-12-31$228,430
Interest on participant loans2020-12-31$6,301
Income. Interest from loans (other than to participants)2020-12-31$0
Interest earned on other investments2020-12-31$5,379
Income. Interest from US Government securities2020-12-31$0
Income. Interest from corporate debt instruments2020-12-31$0
Value of interest in common/collective trusts at end of year2020-12-31$3,119,956
Value of interest in common/collective trusts at beginning of year2020-12-31$2,903,365
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$306,585
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$300,673
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$194,865
Net investment gain/loss from pooled separate accounts2020-12-31$65,741
Net investment gain or loss from common/collective trusts2020-12-31$406,460
Net gain/loss from 103.12 investment entities2020-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$62,829
Employer contributions (assets) at end of year2020-12-31$62,829
Employer contributions (assets) at beginning of year2020-12-31$52,259
Income. Dividends from preferred stock2020-12-31$0
Income. Dividends from common stock2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$203,077
Contract administrator fees2020-12-31$36,650
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$0
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
Aggregate proceeds on sale of assets2020-12-31$0
Aggregate carrying amount (costs) on sale of assets2020-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2020-12-31$0
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31SAMYN&MARTIN
Accountancy firm EIN2020-12-31431679261
2019 : WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2019 401k financial data
Unrealized appreciation/depreciation of real estate assets2019-12-31$0
Unrealized appreciation/depreciation of real estate assets2019-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total transfer of assets to this plan2019-12-31$0
Total transfer of assets to this plan2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Expenses. Interest paid2019-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022019-12-31$0
Expenses. Interest paid2019-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022019-12-31$0
Total income from all sources (including contributions)2019-12-31$1,249,718
Total income from all sources (including contributions)2019-12-31$1,249,718
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$303,306
Total of all expenses incurred2019-12-31$303,306
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$240,515
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$240,515
Expenses. Certain deemed distributions of participant loans2019-12-31$27
Expenses. Certain deemed distributions of participant loans2019-12-31$27
Value of total corrective distributions2019-12-31$29,203
Value of total corrective distributions2019-12-31$29,203
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$446,139
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$446,139
Value of total assets at end of year2019-12-31$5,121,163
Value of total assets at end of year2019-12-31$5,121,163
Value of total assets at beginning of year2019-12-31$4,174,751
Value of total assets at beginning of year2019-12-31$4,174,751
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$33,561
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$33,561
Total income from rents2019-12-31$0
Total income from rents2019-12-31$0
Total interest from all sources2019-12-31$11,556
Total interest from all sources2019-12-31$11,556
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$26,811
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$26,811
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
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$26,811
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$26,811
Administrative expenses professional fees incurred2019-12-31$8,000
Administrative expenses professional fees incurred2019-12-31$8,000
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$500,000
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31Yes
If this is an individual account plan, was there a blackout period2019-12-31Yes
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
Amount of non-exempt transactions with any party-in-interest2019-12-31$0
Amount of non-exempt transactions with any party-in-interest2019-12-31$0
Contributions received from participants2019-12-31$346,166
Contributions received from participants2019-12-31$346,166
Participant contributions at end of year2019-12-31$119,380
Participant contributions at end of year2019-12-31$119,380
Participant contributions at beginning of year2019-12-31$147,020
Participant contributions at beginning of year2019-12-31$147,020
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$0
Participant contributions at beginning of year2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$0
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 beginning of year2019-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$0
Other income not declared elsewhere2019-12-31$0
Other income not declared elsewhere2019-12-31$0
Administrative expenses (other) incurred2019-12-31$0
Administrative expenses (other) incurred2019-12-31$0
Liabilities. Value of operating payables at beginning of year2019-12-31$0
Liabilities. Value of operating payables at beginning of year2019-12-31$0
Total non interest bearing cash at end of year2019-12-31$0
Total non interest bearing cash at end of year2019-12-31$0
Total non interest bearing cash at beginning of year2019-12-31$0
Total non interest bearing cash at beginning of year2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
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
Income. Non cash contributions2019-12-31$0
Income. Non cash contributions2019-12-31$0
Value of net income/loss2019-12-31$946,412
Value of net income/loss2019-12-31$946,412
Value of net assets at end of year (total assets less liabilities)2019-12-31$5,121,163
Value of net assets at end of year (total assets less liabilities)2019-12-31$5,121,163
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$4,174,751
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$4,174,751
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
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2019-12-31$0
Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year2019-12-31$0
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
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2019-12-31$0
Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year2019-12-31$0
Investment advisory and management fees2019-12-31$0
Investment advisory and management fees2019-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$1,480,014
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$1,480,014
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$0
Value of interest in pooled separate accounts at end of year2019-12-31$228,430
Value of interest in pooled separate accounts at end of year2019-12-31$228,430
Value of interest in pooled separate accounts at beginning of year2019-12-31$3,903,151
Value of interest in pooled separate accounts at beginning of year2019-12-31$3,903,151
Interest on participant loans2019-12-31$6,722
Interest on participant loans2019-12-31$6,722
Income. Interest from loans (other than to participants)2019-12-31$0
Income. Interest from loans (other than to participants)2019-12-31$0
Interest earned on other investments2019-12-31$4,834
Interest earned on other investments2019-12-31$4,834
Income. Interest from US Government securities2019-12-31$0
Income. Interest from US Government securities2019-12-31$0
Income. Interest from corporate debt instruments2019-12-31$0
Income. Interest from corporate debt instruments2019-12-31$0
Value of interest in common/collective trusts at end of year2019-12-31$2,903,365
Value of interest in common/collective trusts at end of year2019-12-31$2,903,365
Value of interest in common/collective trusts at beginning of year2019-12-31$0
Value of interest in common/collective trusts at beginning of year2019-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$337,715
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$337,715
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$124,580
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$124,580
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$61,192
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$61,192
Net investment gain/loss from pooled separate accounts2019-12-31$446,755
Net investment gain/loss from pooled separate accounts2019-12-31$446,755
Net investment gain or loss from common/collective trusts2019-12-31$257,265
Net investment gain or loss from common/collective trusts2019-12-31$257,265
Net gain/loss from 103.12 investment entities2019-12-31$0
Net gain/loss from 103.12 investment entities2019-12-31$0
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 contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
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
Contributions received in cash from employer2019-12-31$99,973
Contributions received in cash from employer2019-12-31$99,973
Employer contributions (assets) at end of year2019-12-31$52,259
Employer contributions (assets) at end of year2019-12-31$52,259
Employer contributions (assets) at beginning of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Income. Dividends from preferred stock2019-12-31$0
Income. Dividends from preferred stock2019-12-31$0
Income. Dividends from common stock2019-12-31$0
Income. Dividends from common stock2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$240,515
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$240,515
Contract administrator fees2019-12-31$25,561
Contract administrator fees2019-12-31$25,561
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31Yes
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31Yes
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$0
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
Aggregate proceeds on sale of assets2019-12-31$0
Aggregate proceeds on sale of assets2019-12-31$0
Aggregate carrying amount (costs) on sale of assets2019-12-31$0
Aggregate carrying amount (costs) on sale of assets2019-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2019-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2019-12-31$0
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 name2019-12-31SAMYN&MARTIN
Accountancy firm name2019-12-31SAMYN&MARTIN
Accountancy firm EIN2019-12-31431679261
Accountancy firm EIN2019-12-31431679261
2018 : WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2018 401k financial data
Unrealized appreciation/depreciation of real estate assets2018-12-31$0
Unrealized appreciation/depreciation of other (non real estate) assets2018-12-31$0
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$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Expenses. Interest paid2018-12-31$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022018-12-31$0
Total income from all sources (including contributions)2018-12-31$20,144
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$288,584
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$266,965
Expenses. Certain deemed distributions of participant loans2018-12-31$0
Value of total corrective distributions2018-12-31$15,771
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$389,698
Value of total assets at end of year2018-12-31$4,174,751
Value of total assets at beginning of year2018-12-31$4,443,191
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$5,848
Total income from rents2018-12-31$0
Total interest from all sources2018-12-31$8,765
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
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$0
Assets. Real estate other than employer real property at end of year2018-12-31$0
Assets. Real estate other than employer real property at beginning of year2018-12-31$0
Administrative expenses professional fees incurred2018-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2018-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2018-12-31$0
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$200,000
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$339,170
Participant contributions at end of year2018-12-31$147,020
Participant contributions at beginning of year2018-12-31$146,277
Participant contributions at end of year2018-12-31$0
Participant contributions at beginning of year2018-12-31$0
Assets. Other investments not covered elsewhere at end of year2018-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$7,450
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$0
Assets. Loans (other than to participants) at end of year2018-12-31$0
Assets. Loans (other than to participants) at beginning of year2018-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$0
Other income not declared elsewhere2018-12-31$0
Administrative expenses (other) incurred2018-12-31$0
Total non interest bearing cash at end of year2018-12-31$0
Total non interest bearing cash at beginning of year2018-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Income. Non cash contributions2018-12-31$0
Value of net income/loss2018-12-31$-268,440
Value of net assets at end of year (total assets less liabilities)2018-12-31$4,174,751
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$4,443,191
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
Assets. partnership/joint venture interests at end of year2018-12-31$0
Assets. partnership/joint venture interests at beginning of year2018-12-31$0
Investment advisory and management fees2018-12-31$5,848
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$0
Value of interest in pooled separate accounts at end of year2018-12-31$3,903,151
Value of interest in pooled separate accounts at beginning of year2018-12-31$4,182,662
Interest on participant loans2018-12-31$7,454
Income. Interest from loans (other than to participants)2018-12-31$0
Interest earned on other investments2018-12-31$1,311
Income. Interest from US Government securities2018-12-31$0
Income. Interest from corporate debt instruments2018-12-31$0
Value of interest in master investment trust accounts at end of year2018-12-31$0
Value of interest in master investment trust accounts at beginning of year2018-12-31$0
Value of interest in common/collective trusts at end of year2018-12-31$0
Value of interest in common/collective trusts at beginning of year2018-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2018-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2018-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$124,580
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$114,252
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$0
Asset value of US Government securities at end of year2018-12-31$0
Asset value of US Government securities at beginning of year2018-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$0
Net investment gain/loss from pooled separate accounts2018-12-31$-378,319
Net investment gain or loss from common/collective trusts2018-12-31$0
Net gain/loss from 103.12 investment entities2018-12-31$0
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
Assets. Invements in employer securities at end of year2018-12-31$0
Assets. Invements in employer securities at beginning of year2018-12-31$0
Assets. Value of employer real property at end of year2018-12-31$0
Assets. Value of employer real property at beginning of year2018-12-31$0
Contributions received in cash from employer2018-12-31$43,078
Employer contributions (assets) at end of year2018-12-31$0
Employer contributions (assets) at beginning of year2018-12-31$0
Income. Dividends from preferred stock2018-12-31$0
Income. Dividends from common stock2018-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$266,965
Asset. Corporate debt instrument preferred debt at end of year2018-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2018-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2018-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2018-12-31$0
Contract administrator fees2018-12-31$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Assets. Corporate common stocks other than exployer securities at end of year2018-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2018-12-31$0
Liabilities. Value of benefit claims payable at end of year2018-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2018-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2018-12-31$0
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
Aggregate proceeds on sale of assets2018-12-31$0
Aggregate carrying amount (costs) on sale of assets2018-12-31$0
Liabilities. Value of acquisition indebtedness at end of year2018-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2018-12-31$0
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 name2018-12-31SAMYN&MARTIN, LLC
Accountancy firm EIN2018-12-31431679261

Form 5500 Responses for WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN

2022: WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 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: WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
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: WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
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: WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
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: WORTH HARLEY DAVIDSON 401(K) PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedYes
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 benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number533751
Policy instance 2
Insurance contract or identification number533751
Number of Individuals Covered121
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
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered121
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
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number533751
Policy instance 2
Insurance contract or identification number533751
Number of Individuals Covered126
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered126
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number533751
Policy instance 2
Insurance contract or identification number533751
Number of Individuals Covered120
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $313
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
Commission paid to Insurance BrokerUSD $313
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered120
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $382
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $382
Amount paid for insurance broker fees0
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number933239-01
Policy instance 3
Insurance contract or identification number933239-01
Number of Individuals Covered22
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $7,861
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,861
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number533751
Policy instance 2
Insurance contract or identification number533751
Number of Individuals Covered143
Insurance policy start date2019-06-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $248
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
Commission paid to Insurance BrokerUSD $248
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number613953
Policy instance 1
Insurance contract or identification number613953
Number of Individuals Covered143
Insurance policy start date2019-06-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $415
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $415
Amount paid for insurance broker fees0
Insurance broker organization code?3
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number933239-01
Policy instance 1
Insurance contract or identification number933239-01
Number of Individuals Covered102
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $15,300
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 $15,300
Insurance broker organization code?3

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