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HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 401k Plan overview

Plan NameHEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN
Plan identification number 001

HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN Benefits

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

401k Sponsoring company profile

HEARTLAND SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:HEARTLAND SERVICES, INC.
Employer identification number (EIN):481034346
NAIC Classification:811210
NAIC Description: Electronic and Precision Equipment Repair and Maintenance

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012020-01-01JAYSON CUMMINS2020-12-23
0012018-01-01
0012017-01-01PATRICK COCHERL
0012016-01-01PATRICK COCHERL
0012015-01-01PATRICK COCHERL
0012014-01-01PATRICK COCHERL2015-06-01
0012013-01-01PATRICK COCHERL2014-05-15
0012012-01-01PATRICK COCHERL2013-06-04
0012011-01-01PATRICK COCHERL2012-07-26
0012010-01-01PATRICK COCHERL2011-06-07 PATRICK COCHERL2011-06-07

Plan Statistics for HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN

401k plan membership statisitcs for HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN

Measure Date Value
2018: HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01125
Total number of active participants reported on line 7a of the Form 55002018-01-0110
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-016
Total of all active and inactive participants2018-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0116
Number of participants with account balances2018-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-0150
2017: HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01128
Total number of active participants reported on line 7a of the Form 55002017-01-01101
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-018
Total of all active and inactive participants2017-01-01109
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01109
Number of participants with account balances2017-01-0186
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-0112
2016: HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01131
Total number of active participants reported on line 7a of the Form 55002016-01-01108
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-018
Total of all active and inactive participants2016-01-01116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01116
Number of participants with account balances2016-01-0193
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-019
2015: HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01124
Total number of active participants reported on line 7a of the Form 55002015-01-0196
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0119
Total of all active and inactive participants2015-01-01115
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01115
Number of participants with account balances2015-01-01101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-0115

Financial Data on HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN

Measure Date Value
2018 : HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$2,006
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$19,837
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$3,582,572
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$3,577,696
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$56,453
Value of total assets at end of year2018-12-31$702,315
Value of total assets at beginning of year2018-12-31$4,263,044
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$4,876
Total interest from all sources2018-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$69,787
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$69,787
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$41,543
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$2,006
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$0
Administrative expenses (other) incurred2018-12-31$4,876
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-3,562,735
Value of net assets at end of year (total assets less liabilities)2018-12-31$700,309
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$4,263,044
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$688,464
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$4,234,426
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$13,851
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$25,211
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-106,403
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$14,910
Employer contributions (assets) at end of year2018-12-31$0
Employer contributions (assets) at beginning of year2018-12-31$3,407
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$3,577,696
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
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 name2018-12-31RSM US LLP
Accountancy firm EIN2018-12-31420714325
2017 : HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$861,433
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$250,804
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$238,943
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$296,195
Value of total assets at end of year2017-12-31$4,263,044
Value of total assets at beginning of year2017-12-31$3,652,415
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$11,861
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$202,175
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$202,175
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$213,824
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$9,116
Administrative expenses (other) incurred2017-12-31$11,861
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$610,629
Value of net assets at end of year (total assets less liabilities)2017-12-31$4,263,044
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$3,652,415
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$4,234,426
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$3,613,296
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$25,211
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$36,224
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$363,063
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$73,255
Employer contributions (assets) at end of year2017-12-31$3,407
Employer contributions (assets) at beginning of year2017-12-31$2,895
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$238,943
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
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 name2017-12-31RSM US LLP
Accountancy firm EIN2017-12-31420714325
2016 : HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 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$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$563,906
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$819,711
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$807,479
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$284,152
Value of total assets at end of year2016-12-31$3,652,415
Value of total assets at beginning of year2016-12-31$3,908,220
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$12,232
Total interest from all sources2016-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$175,569
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$175,569
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$211,432
Administrative expenses (other) incurred2016-12-31$12,232
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-255,805
Value of net assets at end of year (total assets less liabilities)2016-12-31$3,652,415
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$3,908,220
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$3,613,296
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$3,865,852
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$36,224
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$37,068
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$104,185
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31Yes
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$72,720
Employer contributions (assets) at end of year2016-12-31$2,895
Employer contributions (assets) at beginning of year2016-12-31$5,300
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$807,479
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
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 name2016-12-31RSM US LLP
Accountancy firm EIN2016-12-31420714325
2015 : HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 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$0
Total income from all sources (including contributions)2015-12-31$270,450
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$356,904
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$344,163
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$301,145
Value of total assets at end of year2015-12-31$3,908,220
Value of total assets at beginning of year2015-12-31$3,994,674
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$12,741
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$289,930
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$289,930
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
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$215,089
Administrative expenses (other) incurred2015-12-31$12,741
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-86,454
Value of net assets at end of year (total assets less liabilities)2015-12-31$3,908,220
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$3,994,674
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$3,865,852
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$3,960,749
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$37,068
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$28,825
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-320,625
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$86,056
Employer contributions (assets) at end of year2015-12-31$5,300
Employer contributions (assets) at beginning of year2015-12-31$5,100
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$344,163
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
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 name2015-12-31RSM US LLP
Accountancy firm EIN2015-12-31420714325

Form 5500 Responses for HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN

2018: HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: HEARTLAND SERVICES, INC. 401(K) SAVINGS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number943755-01
Policy instance 1
Insurance contract or identification number943755-01
Number of Individuals Covered2
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number943755-01
Policy instance 1
Insurance contract or identification number943755-01
Number of Individuals Covered4
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number943755-01
Policy instance 1
Insurance contract or identification number943755-01
Number of Individuals Covered5
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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