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MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 401k Plan overview

Plan NameMIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST
Plan identification number 001

MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST Benefits

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

401k Sponsoring company profile

MIDSTATES, INC. PRINT & MEDIA SOLUTIONS HEALTHCARE PLAN has sponsored the creation of one or more 401k plans.

Company Name:MIDSTATES, INC. PRINT & MEDIA SOLUTIONS HEALTHCARE PLAN
Employer identification number (EIN):460392061
NAIC Classification:323100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST

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
0012019-01-01DAVE BURGARD2020-10-05 DAVE BURGARD2020-10-05
0012018-01-01DAVE BURGARD2019-08-29
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01DAVE BURGARD
0012013-01-01TROY ZWART
0012012-01-01MARK STEWART
0012011-01-01MIKE HAHN
0012009-01-01DAVE BURGARD

Plan Statistics for MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST

401k plan membership statisitcs for MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST

Measure Date Value
2022: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-01265
Total number of active participants reported on line 7a of the Form 55002022-01-01208
Number of retired or separated participants receiving benefits2022-01-012
Number of other retired or separated participants entitled to future benefits2022-01-0173
Total of all active and inactive participants2022-01-01283
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01283
Number of participants with account balances2022-01-01243
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-0110
2021: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-01263
Total number of active participants reported on line 7a of the Form 55002021-01-01189
Number of retired or separated participants receiving benefits2021-01-015
Number of other retired or separated participants entitled to future benefits2021-01-0171
Total of all active and inactive participants2021-01-01265
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01265
Number of participants with account balances2021-01-01228
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-0117
2020: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2020 401k membership
Total participants, beginning-of-year2020-01-01275
Total number of active participants reported on line 7a of the Form 55002020-01-01197
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
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 balances2020-01-01159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-0118
2019: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-01265
Total number of active participants reported on line 7a of the Form 55002019-01-01218
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-0147
Total of all active and inactive participants2019-01-01266
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01266
Number of participants with account balances2019-01-01227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-0115
2018: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2018 401k membership
Total participants, beginning-of-year2018-01-01287
Total number of active participants reported on line 7a of the Form 55002018-01-01210
Number of retired or separated participants receiving benefits2018-01-011
Number of other retired or separated participants entitled to future benefits2018-01-0139
Total of all active and inactive participants2018-01-01250
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01250
Number of participants with account balances2018-01-01215
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-0125
2017: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-01297
Total number of active participants reported on line 7a of the Form 55002017-01-01225
Number of retired or separated participants receiving benefits2017-01-011
Number of other retired or separated participants entitled to future benefits2017-01-0145
Total of all active and inactive participants2017-01-01271
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01271
Number of participants with account balances2017-01-01227
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-0124
2016: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-01358
Total number of active participants reported on line 7a of the Form 55002016-01-01237
Number of retired or separated participants receiving benefits2016-01-011
Number of other retired or separated participants entitled to future benefits2016-01-0149
Total of all active and inactive participants2016-01-01287
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01287
Number of participants with account balances2016-01-01233
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-0139
2015: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-01386
Total number of active participants reported on line 7a of the Form 55002015-01-01290
Number of retired or separated participants receiving benefits2015-01-011
Number of other retired or separated participants entitled to future benefits2015-01-0165
Total of all active and inactive participants2015-01-01356
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01356
Number of participants with account balances2015-01-01290
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-0137
2014: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-01368
Total number of active participants reported on line 7a of the Form 55002014-01-01319
Number of retired or separated participants receiving benefits2014-01-012
Number of other retired or separated participants entitled to future benefits2014-01-0140
Total of all active and inactive participants2014-01-01361
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01361
Number of participants with account balances2014-01-01288
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-0131
2013: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-01254
Total number of active participants reported on line 7a of the Form 55002013-01-01269
Number of retired or separated participants receiving benefits2013-01-013
Number of other retired or separated participants entitled to future benefits2013-01-0111
Total of all active and inactive participants2013-01-01283
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01283
Number of participants with account balances2013-01-01223
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-0110
2012: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-01198
Total number of active participants reported on line 7a of the Form 55002012-01-01196
Number of retired or separated participants receiving benefits2012-01-012
Number of other retired or separated participants entitled to future benefits2012-01-0110
Total of all active and inactive participants2012-01-01208
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01208
Number of participants with account balances2012-01-01162
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-015
2011: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-01215
Total number of active participants reported on line 7a of the Form 55002011-01-01181
Number of retired or separated participants receiving benefits2011-01-015
Number of other retired or separated participants entitled to future benefits2011-01-017
Total of all active and inactive participants2011-01-01193
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-011
Total participants2011-01-01194
Number of participants with account balances2011-01-01158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-019
2009: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-01224
Total number of active participants reported on line 7a of the Form 55002009-01-01202
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0150
Total of all active and inactive participants2009-01-01252
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01252
Number of participants with account balances2009-01-01188
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST

Measure Date Value
2022 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2022 401k financial data
Total income from all sources (including contributions)2022-12-31$-1,478,967
Total of all expenses incurred2022-12-31$1,310,456
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,263,354
Expenses. Certain deemed distributions of participant loans2022-12-31$237
Value of total corrective distributions2022-12-31$3,904
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$575,931
Value of total assets at end of year2022-12-31$8,452,729
Value of total assets at beginning of year2022-12-31$11,242,152
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$42,961
Total interest from all sources2022-12-31$1,795
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$0
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$492,472
Participant contributions at end of year2022-12-31$32,381
Participant contributions at beginning of year2022-12-31$40,717
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$22,348
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$8,034
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-2,789,423
Value of net assets at end of year (total assets less liabilities)2022-12-31$8,452,729
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$11,242,152
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$8,301,158
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$11,099,682
Interest on participant loans2022-12-31$1,795
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$111,156
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$101,753
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-2,056,693
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$61,111
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,263,354
Contract administrator fees2022-12-31$42,961
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 name2022-12-31LB CARLSON, LLP
Accountancy firm EIN2022-12-31411504933
2021 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2021 401k financial data
Total income from all sources (including contributions)2021-12-31$2,010,302
Total of all expenses incurred2021-12-31$1,949,268
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,894,882
Expenses. Certain deemed distributions of participant loans2021-12-31$0
Value of total corrective distributions2021-12-31$3,497
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$540,396
Value of total assets at end of year2021-12-31$11,242,152
Value of total assets at beginning of year2021-12-31$11,181,118
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$50,889
Total interest from all sources2021-12-31$2,305
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$0
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$479,408
Participant contributions at end of year2021-12-31$40,717
Participant contributions at beginning of year2021-12-31$32,512
Participant contributions at end of year2021-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end 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$61,034
Value of net assets at end of year (total assets less liabilities)2021-12-31$11,242,152
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$11,181,118
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$11,099,682
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$10,790,132
Interest on participant loans2021-12-31$2,305
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$101,753
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$358,474
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$1,467,601
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$60,988
Employer contributions (assets) at end of year2021-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,894,882
Contract administrator fees2021-12-31$50,889
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 plan2021-12-31Disclaimer
Accountancy firm name2021-12-31LB CARLSON, LLP
Accountancy firm EIN2021-12-31411504933
2020 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$1,407,027
Total unrealized appreciation/depreciation of assets2020-12-31$1,407,027
Total income from all sources (including contributions)2020-12-31$2,097,485
Total of all expenses incurred2020-12-31$811,392
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$805,734
Expenses. Certain deemed distributions of participant loans2020-12-31$0
Value of total corrective distributions2020-12-31$5,658
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$688,071
Value of total assets at end of year2020-12-31$11,181,118
Value of total assets at beginning of year2020-12-31$9,895,025
Total interest from all sources2020-12-31$2,387
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
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$0
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
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$454,918
Participant contributions at end of year2020-12-31$32,512
Participant contributions at beginning of year2020-12-31$38,473
Participant contributions at beginning of year2020-12-31$17,472
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$176,879
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-12-31$6,692
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$1,286,093
Value of net assets at end of year (total assets less liabilities)2020-12-31$11,181,118
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$9,895,025
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$10,790,132
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$9,771,328
Interest on participant loans2020-12-31$2,387
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$358,474
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$65,555
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$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$56,274
Employer contributions (assets) at beginning of year2020-12-31$2,197
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$799,042
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 name2020-12-31LB CARLSON, LLP
Accountancy firm EIN2020-12-31411504933
2019 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2019 401k financial data
Total income from all sources (including contributions)2019-12-31$2,564,832
Total of all expenses incurred2019-12-31$908,250
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$866,215
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$746,903
Value of total assets at end of year2019-12-31$9,895,025
Value of total assets at beginning of year2019-12-31$8,238,443
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$42,035
Total interest from all sources2019-12-31$2,339
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
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$469,905
Participant contributions at end of year2019-12-31$38,473
Participant contributions at beginning of year2019-12-31$36,509
Participant contributions at end of year2019-12-31$17,472
Participant contributions at beginning of year2019-12-31$17,345
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$219,821
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$1,656,582
Value of net assets at end of year (total assets less liabilities)2019-12-31$9,895,025
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$8,238,443
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$37,426
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$9,771,328
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$8,026,763
Interest on participant loans2019-12-31$2,339
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$65,555
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$155,747
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$1,815,590
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
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$57,177
Employer contributions (assets) at end of year2019-12-31$2,197
Employer contributions (assets) at beginning of year2019-12-31$2,079
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$866,215
Contract administrator fees2019-12-31$4,609
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31VRS P.C.
Accountancy firm EIN2019-12-31460414067
2018 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 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$0
Total income from all sources (including contributions)2018-12-31$221,146
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$524,245
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$470,560
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$602,562
Value of total assets at end of year2018-12-31$8,238,443
Value of total assets at beginning of year2018-12-31$8,541,542
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$53,685
Total interest from all sources2018-12-31$2,462
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$9,648
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
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$474,889
Participant contributions at end of year2018-12-31$36,509
Participant contributions at beginning of year2018-12-31$55,822
Participant contributions at end of year2018-12-31$17,345
Participant contributions at beginning of year2018-12-31$15,141
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$75,684
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-303,099
Value of net assets at end of year (total assets less liabilities)2018-12-31$8,238,443
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$8,541,542
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$8,026,763
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$8,418,791
Interest on participant loans2018-12-31$2,462
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$155,747
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$49,830
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-383,878
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
Contributions received in cash from employer2018-12-31$51,989
Employer contributions (assets) at end of year2018-12-31$2,079
Employer contributions (assets) at beginning of year2018-12-31$1,958
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$470,560
Contract administrator fees2018-12-31$44,037
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 name2018-12-31VRS P.C.
Accountancy firm EIN2018-12-31460414067
2017 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 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$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$3,127
Total income from all sources (including contributions)2017-12-31$1,957,889
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$1,255,558
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$1,226,311
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$596,336
Value of total assets at end of year2017-12-31$8,541,542
Value of total assets at beginning of year2017-12-31$7,842,338
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$29,247
Total interest from all sources2017-12-31$3,281
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$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$433,700
Participant contributions at end of year2017-12-31$55,822
Participant contributions at beginning of year2017-12-31$49,663
Participant contributions at end of year2017-12-31$15,141
Participant contributions at beginning of year2017-12-31$16,151
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$114,839
Liabilities. Value of operating payables at end of year2017-12-31$0
Liabilities. Value of operating payables at beginning of year2017-12-31$3,127
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$702,331
Value of net assets at end of year (total assets less liabilities)2017-12-31$8,541,542
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$7,839,211
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$8,418,791
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$7,728,911
Interest on participant loans2017-12-31$3,281
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$49,830
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$45,519
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$1,358,272
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$47,797
Employer contributions (assets) at end of year2017-12-31$1,958
Employer contributions (assets) at beginning of year2017-12-31$2,094
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$1,226,311
Contract administrator fees2017-12-31$29,247
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 name2017-12-31VRS P.C.
Accountancy firm EIN2017-12-31460414067
2016 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$3,127
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$1,075,122
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$1,154,369
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$1,137,744
Value of total corrective distributions2016-12-31$3,913
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$600,374
Value of total assets at end of year2016-12-31$7,842,338
Value of total assets at beginning of year2016-12-31$7,918,458
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$12,712
Total interest from all sources2016-12-31$2,791
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 bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
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$501,730
Participant contributions at end of year2016-12-31$49,663
Participant contributions at beginning of year2016-12-31$60,166
Participant contributions at end of year2016-12-31$16,151
Participant contributions at beginning of year2016-12-31$15,353
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$53,201
Liabilities. Value of operating payables at end of year2016-12-31$3,127
Liabilities. Value of operating payables at beginning of year2016-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-79,247
Value of net assets at end of year (total assets less liabilities)2016-12-31$7,839,211
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$7,918,458
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$7,728,911
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$7,775,465
Interest on participant loans2016-12-31$2,791
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$45,519
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$67,474
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$471,957
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31Yes
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$45,443
Employer contributions (assets) at end of year2016-12-31$2,094
Employer contributions (assets) at beginning of year2016-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$1,137,744
Contract administrator fees2016-12-31$12,712
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 name2016-12-31VILHAUER RAML & SNYDER P.C.
Accountancy firm EIN2016-12-31460414067
2015 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$62
Total income from all sources (including contributions)2015-12-31$581,570
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$494,692
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$481,507
Value of total corrective distributions2015-12-31$1,729
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$645,492
Value of total assets at end of year2015-12-31$7,918,458
Value of total assets at beginning of year2015-12-31$7,831,642
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$11,456
Total interest from all sources2015-12-31$2,971
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$2,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$549,688
Participant contributions at end of year2015-12-31$60,166
Participant contributions at beginning of year2015-12-31$70,370
Participant contributions at end of year2015-12-31$15,353
Participant contributions at beginning of year2015-12-31$17,183
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$10,473
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$62
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$86,878
Value of net assets at end of year (total assets less liabilities)2015-12-31$7,918,458
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$7,831,580
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$7,775,465
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$7,675,056
Interest on participant loans2015-12-31$2,971
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$67,474
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$64,419
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-66,893
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$85,331
Employer contributions (assets) at end of year2015-12-31$0
Employer contributions (assets) at beginning of year2015-12-31$4,614
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$481,507
Contract administrator fees2015-12-31$11,456
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31VILHAUER RAML & SNYDER P.C.
Accountancy firm EIN2015-12-31460414067
2014 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$62
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$1,120,903
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$422,246
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$397,198
Expenses. Certain deemed distributions of participant loans2014-12-31$14,908
Value of total corrective distributions2014-12-31$1,981
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$775,360
Value of total assets at end of year2014-12-31$7,831,642
Value of total assets at beginning of year2014-12-31$7,132,923
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$8,159
Total interest from all sources2014-12-31$3,083
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$2,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$566,655
Participant contributions at end of year2014-12-31$70,370
Participant contributions at beginning of year2014-12-31$62,287
Participant contributions at end of year2014-12-31$17,183
Participant contributions at beginning of year2014-12-31$3,298
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$57,898
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$62
Other income not declared elsewhere2014-12-31$3
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$698,657
Value of net assets at end of year (total assets less liabilities)2014-12-31$7,831,580
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$7,132,923
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$7,675,056
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$7,002,018
Interest on participant loans2014-12-31$3,083
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$64,419
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$64,419
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$342,457
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$150,807
Employer contributions (assets) at end of year2014-12-31$4,614
Employer contributions (assets) at beginning of year2014-12-31$901
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$397,198
Contract administrator fees2014-12-31$8,159
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31VILHAUER RAML & SNYDER P.C.
Accountancy firm EIN2014-12-31460414067
2013 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$2,498,110
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$137,541
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$114,048
Expenses. Certain deemed distributions of participant loans2013-12-31$5,886
Value of total corrective distributions2013-12-31$261
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,480,733
Value of total assets at end of year2013-12-31$7,132,923
Value of total assets at beginning of year2013-12-31$4,772,354
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$17,346
Total interest from all sources2013-12-31$3,275
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$438,227
Participant contributions at end of year2013-12-31$62,287
Participant contributions at beginning of year2013-12-31$56,486
Participant contributions at end of year2013-12-31$3,298
Participant contributions at beginning of year2013-12-31$14,698
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$919,777
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$2,360,569
Value of net assets at end of year (total assets less liabilities)2013-12-31$7,132,923
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$4,772,354
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$7,002,018
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$4,590,943
Income. Interest from loans (other than to participants)2013-12-31$3,275
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-12-31$64,419
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-12-31$64,106
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$1,014,102
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$122,729
Employer contributions (assets) at end of year2013-12-31$901
Employer contributions (assets) at beginning of year2013-12-31$46,121
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$114,048
Contract administrator fees2013-12-31$17,346
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31VILHAUER RAML & SNYDER P.C.
Accountancy firm EIN2013-12-31460414067
2012 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$1,032,622
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$168,369
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$155,239
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$531,687
Value of total assets at end of year2012-12-31$4,772,354
Value of total assets at beginning of year2012-12-31$3,908,101
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$13,130
Total interest from all sources2012-12-31$1,501
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$360,992
Participant contributions at end of year2012-12-31$56,486
Participant contributions at beginning of year2012-12-31$50,699
Participant contributions at end of year2012-12-31$14,698
Participant contributions at beginning of year2012-12-31$14,081
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$28,095
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$864,253
Value of net assets at end of year (total assets less liabilities)2012-12-31$4,772,354
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$3,908,101
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$4,590,943
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$3,764,028
Income. Interest from loans (other than to participants)2012-12-31$1,501
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$64,106
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$34,734
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$499,434
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$142,600
Employer contributions (assets) at end of year2012-12-31$46,121
Employer contributions (assets) at beginning of year2012-12-31$44,559
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$155,239
Contract administrator fees2012-12-31$13,130
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31VILHAUER RAML & SNYDER PC
Accountancy firm EIN2012-12-31460414067
2011 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$416,057
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$409,268
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$397,946
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$509,481
Value of total assets at end of year2011-12-31$3,908,101
Value of total assets at beginning of year2011-12-31$3,901,312
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$11,322
Total interest from all sources2011-12-31$3,924
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$300,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$361,602
Participant contributions at end of year2011-12-31$50,699
Participant contributions at beginning of year2011-12-31$54,295
Participant contributions at end of year2011-12-31$14,081
Participant contributions at beginning of year2011-12-31$158
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$795
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$6,789
Value of net assets at end of year (total assets less liabilities)2011-12-31$3,908,101
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$3,901,312
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$3,764,028
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$3,774,975
Interest on participant loans2011-12-31$3,924
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$34,734
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$28,415
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-97,348
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$147,084
Employer contributions (assets) at end of year2011-12-31$44,559
Employer contributions (assets) at beginning of year2011-12-31$43,469
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$397,946
Contract administrator fees2011-12-31$11,322
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31VILHAUER RAML & SNYDER PC
Accountancy firm EIN2011-12-31460414067
2010 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$172
Total income from all sources (including contributions)2010-12-31$893,280
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$123,376
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$114,640
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$497,860
Value of total assets at end of year2010-12-31$3,901,312
Value of total assets at beginning of year2010-12-31$3,131,580
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$8,736
Total interest from all sources2010-12-31$1,935
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$8,736
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$300,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$348,798
Participant contributions at end of year2010-12-31$54,295
Participant contributions at beginning of year2010-12-31$43,958
Participant contributions at end of year2010-12-31$158
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$1,151
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$172
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$769,904
Value of net assets at end of year (total assets less liabilities)2010-12-31$3,901,312
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$3,131,408
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$3,774,975
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$2,840,791
Income. Interest from loans (other than to participants)2010-12-31$1,935
Value of interest in common/collective trusts at beginning of year2010-12-31$246,660
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$171
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$171
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$28,415
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$393,485
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$147,911
Employer contributions (assets) at end of year2010-12-31$43,469
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$114,640
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31HANSON VILHAUER & RAML PC
Accountancy firm EIN2010-12-31460414067
2009 : MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST

2022: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
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: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
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: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
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: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
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: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 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: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 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: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: MIDSTATES, INC. 401(K) RETIREMENT PLAN AND TRUST 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-KD2T
Policy instance 1
Insurance contract or identification numberGAP-B2-KD2T
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $155
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-KD2T
Policy instance 1
Insurance contract or identification numberGAP-B2-KD2T
Number of Individuals Covered228
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $296
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-KD2T
Policy instance 1
Insurance contract or identification numberGAP-B2-KD2T
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-KD2T
Policy instance 1
Insurance contract or identification numberGAP-B2-KD2T
Number of Individuals Covered227
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $75
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75
Insurance broker organization code?3
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-CTIE
Policy instance 1
Insurance contract or identification numberGAP-B2-CTIE
Number of Individuals Covered227
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $57
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $57
Insurance broker organization code?3
Insurance broker nameAMERIPRISE FINANCIAL SERVICES
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-CTIE
Policy instance 1
Insurance contract or identification numberGAP-B2-CTIE
Number of Individuals Covered278
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $68
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68
Insurance broker organization code?3
Insurance broker nameAMERIPRISE FINANCIAL SERVICES
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-CTIE
Policy instance 1
Insurance contract or identification numberGAP-B2-CTIE
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $91
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $43
Insurance broker organization code?3
Insurance broker nameAMERIPRISE FINANCIAL SERVICES
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-CTIE
Policy instance 1
Insurance contract or identification numberGAP-B2-CTIE
Number of Individuals Covered8
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $128
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $128
Insurance broker organization code?3
Insurance broker nameWADDELL & REED INC.
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-CTIE
Policy instance 1
Insurance contract or identification numberGAP-B2-CTIE
Number of Individuals Covered8
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $101
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $101
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameWADDELL & REED INC.
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-CTIE
Policy instance 1
Insurance contract or identification numberGAP-B2-CTIE
Number of Individuals Covered158
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $64
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-CTIE
Policy instance 1
Insurance contract or identification numberGAP-B2-CTIE
Number of Individuals Covered165
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $49
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No

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