401k Plan data: SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN plan

SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 401k Plan overview

Plan Name	SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN
Plan identification number	001

SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

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

401k Sponsoring company profile

SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC has sponsored the creation of one or more 401k plans.

Company Name: SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC

Employer identification number (EIN): 461723043

NAIC Classification: 211120
NAIC Description: Crude Petroleum Extraction

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01 D MARK TYLER
001 2014-01-01 D MARK TYLER
001 2013-01-01

Plan Statistics for SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN

401k plan membership statisitcs for SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN

Measure Date Value
2016: SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 48
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 19
Total of all active and inactive participants 2016-01-01 68
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 68
Number of participants with account balances 2016-01-01 51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 138
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 69
Number of retired or separated participants receiving benefits 2015-01-01 10
Number of other retired or separated participants entitled to future benefits 2015-01-01 59
Total of all active and inactive participants 2015-01-01 138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 138
Number of participants with account balances 2015-01-01 122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 35
2014: SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 133
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 85
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 35
Total of all active and inactive participants 2014-01-01 121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 121
Number of participants with account balances 2014-01-01 96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 1

Measure	Date	Value
2016: SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	48
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	19
Total of all active and inactive participants	2016-01-01	68
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	68
Number of participants with account balances	2016-01-01	51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	138
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	69
Number of retired or separated participants receiving benefits	2015-01-01	10
Number of other retired or separated participants entitled to future benefits	2015-01-01	59
Total of all active and inactive participants	2015-01-01	138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	138
Number of participants with account balances	2015-01-01	122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	35
2014: SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	133
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	85
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	35
Total of all active and inactive participants	2014-01-01	121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	121
Number of participants with account balances	2014-01-01	96
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	1

Financial Data on SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN

Measure	Date	Value
2016 : SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total income from all sources (including contributions)	2016-12-31	$199,343
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$1,178,112
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$1,163,750
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$85,844
Value of total assets at end of year	2016-12-31	$1,119,766
Value of total assets at beginning of year	2016-12-31	$2,098,535
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$14,362
Total interest from all sources	2016-12-31	$5,030
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 year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$9,000
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$204,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$76,494
Participant contributions at end of year	2016-12-31	$36,209
Participant contributions at beginning of year	2016-12-31	$80,763
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-978,769
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,119,766
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$2,098,535
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Investment advisory and management fees	2016-12-31	$3,750
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$965,655
Value of interest in pooled separate accounts at beginning of year	2016-12-31	$1,829,705
Interest on participant loans	2016-12-31	$3,324
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$1,706
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$117,902
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$188,067
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$108,469
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$9,350
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$1,163,750
Contract administrator fees	2016-12-31	$1,612
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	WAYNE MANNING, CPA
Accountancy firm EIN	2016-12-31	452067234
2015 : SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$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	$0
Total income from all sources (including contributions)	2015-12-31	$229,495
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$133,522
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$114,822
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$287,317
Value of total assets at end of year	2015-12-31	$2,098,535
Value of total assets at beginning of year	2015-12-31	$2,002,562
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$18,700
Total interest from all sources	2015-12-31	$6,212
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 year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$9,500
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$204,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$181,535
Participant contributions at end of year	2015-12-31	$80,763
Participant contributions at beginning of year	2015-12-31	$96,883
Participant contributions at beginning of year	2015-12-31	$1
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$95,973
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$2,098,535
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$2,002,562
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Investment advisory and management fees	2015-12-31	$5,655
Value of interest in pooled separate accounts at end of year	2015-12-31	$1,829,705
Value of interest in pooled separate accounts at beginning of year	2015-12-31	$1,754,655
Interest on participant loans	2015-12-31	$4,140
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$2,072
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$188,067
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$151,022
Net investment gain/loss from pooled separate accounts	2015-12-31	$-64,034
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$105,782
Employer contributions (assets) at beginning of year	2015-12-31	$1
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$114,822
Contract administrator fees	2015-12-31	$3,545
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	WAYNE MANNING, CPA
Accountancy firm EIN	2015-12-31	452067234
2014 : SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
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	$421,152
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$582,143
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$576,076
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$342,155
Value of total assets at end of year	2014-12-31	$2,002,562
Value of total assets at beginning of year	2014-12-31	$2,163,553
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$6,067
Total interest from all sources	2014-12-31	$5,757
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 year	2014-12-31	No
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$204,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$214,945
Participant contributions at end of year	2014-12-31	$96,883
Participant contributions at beginning of year	2014-12-31	$64,822
Participant contributions at end of year	2014-12-31	$1
Participant contributions at beginning of year	2014-12-31	$592
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-160,991
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$2,002,562
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,163,553
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in pooled separate accounts at end of year	2014-12-31	$1,754,655
Value of interest in pooled separate accounts at beginning of year	2014-12-31	$1,960,795
Interest on participant loans	2014-12-31	$4,482
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$1,275
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$151,022
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$136,889
Net investment gain/loss from pooled separate accounts	2014-12-31	$73,240
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$127,210
Employer contributions (assets) at end of year	2014-12-31	$1
Employer contributions (assets) at beginning of year	2014-12-31	$455
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$576,076
Contract administrator fees	2014-12-31	$6,067
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	WAYNE MANNING, CPA
Accountancy firm EIN	2014-12-31	452067234

Form 5500 Responses for SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN

2016: SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC 401K PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

945549-01

Policy instance

Insurance contract or identification number	945549-01
Number of Individuals Covered	114
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $7,921
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $7,921
Insurance broker organization code?	3
Insurance broker name	VAN PEARCY

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

945549-01

Policy instance

Insurance contract or identification number	945549-01
Number of Individuals Covered	96
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,985
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $7,985
Insurance broker organization code?	3
Insurance broker name	VAN PEARCY

Potentially related plans

SELMAN AND ASSOCIATES LTD 401K PROFIT SHARING PLAN [EIN = 751897286]

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Company Name:	SELMAN AND ASSOCIATES INC DBA SELMAN GEO SERVICES INC
Employer identification number (EIN):	461723043
NAIC Classification:	211120
NAIC Description:	Crude Petroleum Extraction

Plan id#	Filing Submission Date	Name of Administrator
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2017-01-01
001	2016-01-01
001	2015-01-01	D MARK TYLER
001	2014-01-01	D MARK TYLER
001	2013-01-01