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XYNGULAR/PURE HAVEN 401(K) PLAN 401k Plan overview

Plan NameXYNGULAR/PURE HAVEN 401(K) PLAN
Plan identification number 001

XYNGULAR/PURE HAVEN 401(K) PLAN Benefits

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

XYNGULAR CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:XYNGULAR CORPORATION
Employer identification number (EIN):452702985
NAIC Classification:454390
NAIC Description:Other Direct Selling Establishments

Additional information about XYNGULAR CORPORATION

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 2005-06-06
Company Identification Number: 20051355389
Legal Registered Office Address: 2215-B RENAISSANCE DR

LAS VEGAS
United States of America (USA)
89119

More information about XYNGULAR CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan XYNGULAR/PURE HAVEN 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01CASSIE JENSEN
0012016-01-01CASSIE JENSEN

Plan Statistics for XYNGULAR/PURE HAVEN 401(K) PLAN

401k plan membership statisitcs for XYNGULAR/PURE HAVEN 401(K) PLAN

Measure Date Value
2022: XYNGULAR/PURE HAVEN 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01252
Total number of active participants reported on line 7a of the Form 55002022-01-01148
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0163
Total of all active and inactive participants2022-01-01211
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01211
Number of participants with account balances2022-01-01165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: XYNGULAR/PURE HAVEN 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01197
Total number of active participants reported on line 7a of the Form 55002021-01-01207
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0145
Total of all active and inactive participants2021-01-01252
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01252
Number of participants with account balances2021-01-01175
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: XYNGULAR/PURE HAVEN 401(K) PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01195
Total number of active participants reported on line 7a of the Form 55002020-01-01168
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 participants2020-01-01197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01197
Number of participants with account balances2020-01-01129
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: XYNGULAR/PURE HAVEN 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01192
Total number of active participants reported on line 7a of the Form 55002019-01-01169
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0126
Total of all active and inactive participants2019-01-01195
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01195
Number of participants with account balances2019-01-01106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: XYNGULAR/PURE HAVEN 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01157
Total number of active participants reported on line 7a of the Form 55002018-01-01162
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0130
Total of all active and inactive participants2018-01-01192
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01192
Number of participants with account balances2018-01-01101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: XYNGULAR/PURE HAVEN 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01151
Total number of active participants reported on line 7a of the Form 55002017-01-01127
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0130
Total of all active and inactive participants2017-01-01157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01157
Number of participants with account balances2017-01-0193
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: XYNGULAR/PURE HAVEN 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01107
Total number of active participants reported on line 7a of the Form 55002016-01-01130
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0121
Total of all active and inactive participants2016-01-01151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01151
Number of participants with account balances2016-01-0178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010

Financial Data on XYNGULAR/PURE HAVEN 401(K) PLAN

Measure Date Value
2022 : XYNGULAR/PURE HAVEN 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-133,682
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$803,100
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$744,061
Expenses. Certain deemed distributions of participant loans2022-12-31$376
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,225,868
Value of total assets at end of year2022-12-31$6,521,908
Value of total assets at beginning of year2022-12-31$7,458,690
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$58,663
Total interest from all sources2022-12-31$1,917
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$103,337
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$103,337
Administrative expenses professional fees incurred2022-12-31$58,663
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$801,809
Participant contributions at end of year2022-12-31$39,858
Participant contributions at beginning of year2022-12-31$26,168
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$4,056
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-936,782
Value of net assets at end of year (total assets less liabilities)2022-12-31$6,521,908
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$7,458,690
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$2,489,942
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$3,110,023
Income. Interest from loans (other than to participants)2022-12-31$1,892
Value of interest in common/collective trusts at end of year2022-12-31$3,962,686
Value of interest in common/collective trusts at beginning of year2022-12-31$4,303,087
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$25
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$29,422
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$19,412
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-703,121
Net investment gain or loss from common/collective trusts2022-12-31$-761,683
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$420,003
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$744,061
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 name2022-12-31WSRP, LLC
Accountancy firm EIN2022-12-31870517754
2021 : XYNGULAR/PURE HAVEN 401(K) 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$2,288,990
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$177,284
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$112,000
Expenses. Certain deemed distributions of participant loans2021-12-31$8,049
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,397,482
Value of total assets at end of year2021-12-31$7,458,690
Value of total assets at beginning of year2021-12-31$5,346,984
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$57,235
Total interest from all sources2021-12-31$1,642
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$259,646
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$259,646
Administrative expenses professional fees incurred2021-12-31$57,235
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$763,391
Participant contributions at end of year2021-12-31$26,168
Participant contributions at beginning of year2021-12-31$27,744
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$231,334
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$0
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$2,111,706
Value of net assets at end of year (total assets less liabilities)2021-12-31$7,458,690
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$5,346,984
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$3,110,023
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$2,747,693
Interest on participant loans2021-12-31$1,623
Value of interest in common/collective trusts at end of year2021-12-31$4,303,087
Value of interest in common/collective trusts at beginning of year2021-12-31$2,562,021
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$19
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$19,412
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$9,526
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$29,359
Net investment gain or loss from common/collective trusts2021-12-31$600,861
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$402,757
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$112,000
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 name2021-12-31WSRP, LLC
Accountancy firm EIN2021-12-31870517754
2020 : XYNGULAR/PURE HAVEN 401(K) PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$1,049
Total income from all sources (including contributions)2020-12-31$1,889,953
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$388,460
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$346,847
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$978,110
Value of total assets at end of year2020-12-31$5,346,984
Value of total assets at beginning of year2020-12-31$3,846,540
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$41,613
Total interest from all sources2020-12-31$2,061
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$41,613
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
Contributions received from participants2020-12-31$539,888
Participant contributions at end of year2020-12-31$27,744
Participant contributions at beginning of year2020-12-31$47,907
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$125,762
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 end of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$1,049
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$1,501,493
Value of net assets at end of year (total assets less liabilities)2020-12-31$5,346,984
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$3,845,491
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$2,747,693
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$1,928,752
Income. Interest from loans (other than to participants)2020-12-31$2,042
Value of interest in common/collective trusts at end of year2020-12-31$2,562,021
Value of interest in common/collective trusts at beginning of year2020-12-31$1,760,552
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$19
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$9,526
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$109,329
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$522,470
Net investment gain or loss from common/collective trusts2020-12-31$387,312
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$312,460
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$346,847
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31WSRP, LLC
Accountancy firm EIN2020-12-31870517754
2019 : XYNGULAR/PURE HAVEN 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$1,049
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$1,049
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
Total income from all sources (including contributions)2019-12-31$1,544,231
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$153,650
Total of all expenses incurred2019-12-31$153,650
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$121,857
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$121,857
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$888,974
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$888,974
Value of total assets at end of year2019-12-31$3,846,540
Value of total assets at end of year2019-12-31$3,846,540
Value of total assets at beginning of year2019-12-31$2,454,910
Value of total assets at beginning of year2019-12-31$2,454,910
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$31,793
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$31,793
Total interest from all sources2019-12-31$2,269
Total interest from all sources2019-12-31$2,269
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
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$400,000
Value of fidelity bond cover2019-12-31$400,000
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
Contributions received from participants2019-12-31$420,801
Contributions received from participants2019-12-31$420,801
Participant contributions at end of year2019-12-31$47,907
Participant contributions at end of year2019-12-31$47,907
Participant contributions at beginning of year2019-12-31$33,445
Participant contributions at beginning of year2019-12-31$33,445
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$221,391
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$221,391
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 end of year2019-12-31$1,049
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$1,049
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
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$1,390,581
Value of net income/loss2019-12-31$1,390,581
Value of net assets at end of year (total assets less liabilities)2019-12-31$3,845,491
Value of net assets at end of year (total assets less liabilities)2019-12-31$3,845,491
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$2,454,910
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$2,454,910
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$1,928,752
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$1,928,752
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$1,520,458
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$1,520,458
Interest on participant loans2019-12-31$2,256
Interest on participant loans2019-12-31$2,256
Value of interest in common/collective trusts at end of year2019-12-31$1,760,552
Value of interest in common/collective trusts at end of year2019-12-31$1,760,552
Value of interest in common/collective trusts at beginning of year2019-12-31$899,896
Value of interest in common/collective trusts at beginning of year2019-12-31$899,896
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$13
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$13
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$109,329
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$109,329
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$1,111
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$1,111
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$400,413
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$400,413
Net investment gain or loss from common/collective trusts2019-12-31$252,575
Net investment gain or loss from common/collective trusts2019-12-31$252,575
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$246,782
Contributions received in cash from employer2019-12-31$246,782
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$121,857
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$121,857
Contract administrator fees2019-12-31$31,793
Contract administrator fees2019-12-31$31,793
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
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
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 name2019-12-31WSRP, LLC
Accountancy firm name2019-12-31WSRP, LLC
Accountancy firm EIN2019-12-31870517754
Accountancy firm EIN2019-12-31870517754
2018 : XYNGULAR/PURE HAVEN 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$1,231
Total income from all sources (including contributions)2018-12-31$416,575
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$246,192
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$215,755
Expenses. Certain deemed distributions of participant loans2018-12-31$1,909
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$557,745
Value of total assets at end of year2018-12-31$2,454,910
Value of total assets at beginning of year2018-12-31$2,285,758
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$28,528
Total interest from all sources2018-12-31$944
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
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$250,000
If this is an individual account plan, was there a blackout period2018-12-31Yes
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$352,500
Participant contributions at end of year2018-12-31$33,445
Participant contributions at beginning of year2018-12-31$4,048
Participant contributions at end of year2018-12-31$0
Participant contributions at beginning of year2018-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$417
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
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$1,231
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$170,383
Value of net assets at end of year (total assets less liabilities)2018-12-31$2,454,910
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$2,284,527
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$1,520,458
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$1,297,995
Interest on participant loans2018-12-31$934
Value of interest in common/collective trusts at end of year2018-12-31$899,896
Value of interest in common/collective trusts at beginning of year2018-12-31$983,030
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$10
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$1,111
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$685
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-142,114
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 contributions2018-12-31Yes
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$204,828
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$215,755
Contract administrator fees2018-12-31$28,528
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31Yes
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31WSRP, LLC
Accountancy firm EIN2018-12-31870517754
2017 : XYNGULAR/PURE HAVEN 401(K) PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$1,231
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$947,946
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$97,909
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$79,330
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$618,673
Value of total assets at end of year2017-12-31$2,285,758
Value of total assets at beginning of year2017-12-31$1,434,490
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$18,579
Total interest from all sources2017-12-31$129
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$210,000
If this is an individual account plan, was there a blackout period2017-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$314,328
Participant contributions at end of year2017-12-31$4,048
Participant contributions at beginning of year2017-12-31$0
Participant contributions at end of year2017-12-31$0
Participant contributions at beginning of year2017-12-31$946
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$116,443
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$1,399
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$1,231
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$850,037
Value of net assets at end of year (total assets less liabilities)2017-12-31$2,284,527
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$1,434,490
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$1,297,995
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$635,321
Income. Interest from loans (other than to participants)2017-12-31$129
Value of interest in common/collective trusts at end of year2017-12-31$983,030
Value of interest in common/collective trusts at beginning of year2017-12-31$766,355
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$685
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$30,469
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$329,144
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31Yes
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$187,902
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$79,330
Contract administrator fees2017-12-31$18,579
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31Yes
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31WSRP, LLC
Accountancy firm EIN2017-12-31870517754
2016 : XYNGULAR/PURE HAVEN 401(K) PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total transfer of assets to this plan2016-12-31$1,061,030
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$510,440
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$136,980
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$131,128
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$433,489
Value of total assets at end of year2016-12-31$1,434,490
Value of total assets at beginning of year2016-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$5,852
Total interest from all sources2016-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31No
If this is an individual account plan, was there a blackout period2016-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$242,360
Participant contributions at end of year2016-12-31$946
Participant contributions at beginning of year2016-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$26,233
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$1,399
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$373,460
Value of net assets at end of year (total assets less liabilities)2016-12-31$1,434,490
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$635,321
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$0
Value of interest in common/collective trusts at end of year2016-12-31$766,355
Value of interest in common/collective trusts at beginning of year2016-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$30,469
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$76,951
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31Yes
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$164,896
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$131,128
Contract administrator fees2016-12-31$5,852
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31Yes
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31WSRP, LLC
Accountancy firm EIN2016-12-31870517754

Form 5500 Responses for XYNGULAR/PURE HAVEN 401(K) PLAN

2022: XYNGULAR/PURE HAVEN 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: XYNGULAR/PURE HAVEN 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: XYNGULAR/PURE HAVEN 401(K) PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: XYNGULAR/PURE HAVEN 401(K) PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: XYNGULAR/PURE HAVEN 401(K) PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: XYNGULAR/PURE HAVEN 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: XYNGULAR/PURE HAVEN 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
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

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number374303-01
Policy instance 1
Insurance contract or identification number374303-01
Number of Individuals Covered17
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
Other information about contractGROUP ANNUITY CONTRACT
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number374303-01
Policy instance 1
Insurance contract or identification number374303-01
Number of Individuals Covered17
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number374303-01
Policy instance 1
Insurance contract or identification number374303-01
Number of Individuals Covered10
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number374303-01
Policy instance 1
Insurance contract or identification number374303-01
Number of Individuals Covered7
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number374303-01
Policy instance 1
Insurance contract or identification number374303-01
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?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

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