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MSI 401(K) BASIC PLAN 401k Plan overview

Plan NameMSI 401(K) BASIC PLAN
Plan identification number 002

MSI 401(K) BASIC 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.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.

401k Sponsoring company profile

MANAGEMENT SYSTEMS INTERNATIONAL has sponsored the creation of one or more 401k plans.

Company Name:MANAGEMENT SYSTEMS INTERNATIONAL
Employer identification number (EIN):521215041
NAIC Classification:541600

Additional information about MANAGEMENT SYSTEMS INTERNATIONAL

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 1996-05-02
Company Identification Number: 19961120600

More information about MANAGEMENT SYSTEMS INTERNATIONAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MSI 401(K) BASIC PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022016-01-01KEITH BROWN
0022016-01-01
0022015-01-01KEITH BROWN
0022014-01-01KEITH BROWN KEITH BROWN2015-10-09
0022013-01-01LAWRENCE COOLEY2014-07-31 LAWRENCE COOLEY2014-07-31
0022012-01-01LAWRENCE COOLEY2013-07-01 LAWRENCE COOLEY2013-07-01
0022011-01-01LAWRENCE COOLEY2012-07-26 LAWRENCE COOLEY2012-07-26
0022010-01-01LAWRENCE COOLEY LAWRENCE COOLEY2011-07-15
0022009-01-01LAWRENCE COOLEY LAWRENCE COOLEY2010-10-07

Plan Statistics for MSI 401(K) BASIC PLAN

401k plan membership statisitcs for MSI 401(K) BASIC PLAN

Measure Date Value
2016: MSI 401(K) BASIC PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01121
Total number of active participants reported on line 7a of the Form 55002016-01-0186
Number of retired or separated participants receiving benefits2016-01-016
Number of other retired or separated participants entitled to future benefits2016-01-0138
Total of all active and inactive participants2016-01-01130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01130
Number of participants with account balances2016-01-01106
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-0120
2015: MSI 401(K) BASIC PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01140
Total number of active participants reported on line 7a of the Form 55002015-01-0178
Number of retired or separated participants receiving benefits2015-01-015
Number of other retired or separated participants entitled to future benefits2015-01-0131
Total of all active and inactive participants2015-01-01114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01114
Number of participants with account balances2015-01-01102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-0120
2014: MSI 401(K) BASIC PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01125
Total number of active participants reported on line 7a of the Form 55002014-01-0185
Number of retired or separated participants receiving benefits2014-01-014
Number of other retired or separated participants entitled to future benefits2014-01-0162
Total of all active and inactive participants2014-01-01151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01151
Number of participants with account balances2014-01-01119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-0113
2010: MSI 401(K) BASIC PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0197
Total number of active participants reported on line 7a of the Form 55002010-01-0151
Number of retired or separated participants receiving benefits2010-01-011
Number of other retired or separated participants entitled to future benefits2010-01-0148
Total of all active and inactive participants2010-01-01100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01100
Number of participants with account balances2010-01-0184
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-017
2009: MSI 401(K) BASIC PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0178
Total number of active participants reported on line 7a of the Form 55002009-01-0176
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0121
Total of all active and inactive participants2009-01-0197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0197
Number of participants with account balances2009-01-0171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on MSI 401(K) BASIC PLAN

Measure Date Value
2016 : MSI 401(K) BASIC PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total transfer of assets from this plan2016-12-31$122,274
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$613,336
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$488,416
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$484,205
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$481,601
Value of total assets at end of year2016-12-31$1,679,323
Value of total assets at beginning of year2016-12-31$1,676,677
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$4,211
Total interest from all sources2016-12-31$24
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
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2016-12-31$0
Administrative expenses professional fees incurred2016-12-31$4,211
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$400,199
Participant contributions at end of year2016-12-31$918
Participant contributions at beginning of year2016-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$22,014
Other income not declared elsewhere2016-12-31$2,364
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$124,920
Value of net assets at end of year (total assets less liabilities)2016-12-31$1,679,323
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$1,676,677
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$1,594,089
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$1,617,023
Interest on participant loans2016-12-31$24
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$84,316
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$59,654
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$129,347
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 contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$59,388
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$484,205
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 name2016-12-31ELLIN & TUCKER, CHARTERED
Accountancy firm EIN2016-12-31520959934
2015 : MSI 401(K) BASIC PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total transfer of assets to this plan2015-12-31$8,742
Total transfer of assets from this plan2015-12-31$392,294
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$10
Total income from all sources (including contributions)2015-12-31$389,709
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$1,260,912
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$1,254,929
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$352,238
Value of total assets at end of year2015-12-31$1,676,677
Value of total assets at beginning of year2015-12-31$2,931,442
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$5,983
Total interest from all sources2015-12-31$0
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
Administrative expenses professional fees incurred2015-12-31$5,983
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$306,906
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$10
Other income not declared elsewhere2015-12-31$3,083
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-871,203
Value of net assets at end of year (total assets less liabilities)2015-12-31$1,676,677
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$2,931,432
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$1,617,023
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$2,887,965
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$59,654
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$43,477
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$34,388
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$45,332
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$1,254,929
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 name2015-12-31ELLIN & TUCKER, CHARTERED
Accountancy firm EIN2015-12-31520959934
2014 : MSI 401(K) BASIC PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total transfer of assets to this plan2014-12-31$968,646
Total transfer of assets from this plan2014-12-31$177,088
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$10
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$516,070
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$154,976
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$151,244
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$361,189
Value of total assets at end of year2014-12-31$2,931,442
Value of total assets at beginning of year2014-12-31$1,778,780
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$3,732
Total interest from all sources2014-12-31$452
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
Administrative expenses professional fees incurred2014-12-31$3,732
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
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$319,958
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$4,130
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$10
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$361,094
Value of net assets at end of year (total assets less liabilities)2014-12-31$2,931,432
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$1,778,780
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$2,887,965
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$1,735,727
Interest on participant loans2014-12-31$452
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$43,477
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$40,197
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$154,429
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$37,101
Employer contributions (assets) at beginning of year2014-12-31$2,856
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$151,244
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 name2014-12-31ELLIN & TUCKER, CHARTERED
Accountancy firm EIN2014-12-31520959934
2010 : MSI 401(K) BASIC PLAN 2010 401k financial data
Total income from all sources2010-12-31$743,092
Expenses. Total of all expenses incurred2010-12-31$201,046
Benefits paid (including direct rollovers)2010-12-31$199,830
Total plan assets at end of year2010-12-31$1,549,863
Total plan assets at beginning of year2010-12-31$1,007,817
Value of fidelity bond covering the plan2010-12-31$1,000,000
Total contributions received or receivable from participants2010-12-31$472,470
Expenses. Other expenses not covered elsewhere2010-12-31$1,216
Contributions received from other sources (not participants or employers)2010-12-31$16,226
Other income received2010-12-31$181,016
Net income (gross income less expenses)2010-12-31$542,046
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,549,863
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,007,817
Assets. Value of participant loans2010-12-31$9,206
Total contributions received or receivable from employer(s)2010-12-31$73,380
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : MSI 401(K) BASIC PLAN 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 MSI 401(K) BASIC PLAN

2016: MSI 401(K) BASIC 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: MSI 401(K) BASIC 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
2014: MSI 401(K) BASIC PLAN 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
2010: MSI 401(K) BASIC PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement - TrustYes
2009: MSI 401(K) BASIC PLAN 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 – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan 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 number336011-01
Policy instance 1
Insurance contract or identification number336011-01
Number of Individuals Covered3
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $101
Insurance broker organization code?3
Insurance broker nameMASS MUTUAL LIFE INSURANCE COMPANY
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number336011-01
Policy instance 1
Insurance contract or identification number336011-01
Number of Individuals Covered4
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $55
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?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
Commission paid to Insurance BrokerUSD $55
Insurance broker organization code?3
Insurance broker nameMASS MUTUAL LIFE INSURANCE COMPANY
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-B2-ZW92
Policy instance 1
Insurance contract or identification numberGAP-B2-ZW92
Number of Individuals Covered3
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
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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