MIEN DOOR KIOUNE, M.D. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN
401k plan membership statisitcs for MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN
| Measure | Date | Value |
|---|
| 2022: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 1 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 1 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2022-01-01 | 0 |
| Total participants | 2022-01-01 | 1 |
| Number of participants with account balances | 2022-01-01 | 1 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2022-01-01 | 0 |
| 2021: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 1 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 1 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2021-01-01 | 0 |
| Total participants | 2021-01-01 | 1 |
| Number of participants with account balances | 2021-01-01 | 1 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2021-01-01 | 0 |
| 2020: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 1 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 1 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2020-01-01 | 0 |
| Total participants | 2020-01-01 | 1 |
| Number of participants with account balances | 2020-01-01 | 1 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2020-01-01 | 0 |
| 2019: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 1 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 1 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2019-01-01 | 0 |
| Total participants | 2019-01-01 | 1 |
| Number of participants with account balances | 2019-01-01 | 1 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2019-01-01 | 0 |
| 2018: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 1 |
| Total of all active and inactive participants | 2018-01-01 | 3 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 1 |
| Total participants | 2018-01-01 | 4 |
| Number of participants with account balances | 2018-01-01 | 1 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-01-01 | 0 |
| 2017: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 2 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 1 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 1 |
| Total of all active and inactive participants | 2017-01-01 | 2 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-01-01 | 0 |
| Total participants | 2017-01-01 | 2 |
| Number of participants with account balances | 2017-01-01 | 2 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-01-01 | 0 |
| Measure | Date | Value |
|---|
| 2022 : MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2022 401k financial data |
|---|
| Total income from all sources | 2022-12-31 | $-401,557 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $0 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $0 |
| Total plan assets at end of year | 2022-12-31 | $2,690,598 |
| Total plan assets at beginning of year | 2022-12-31 | $3,092,155 |
| Value of fidelity bond covering the plan | 2022-12-31 | $2,500,000 |
| Total contributions received or receivable from participants | 2022-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2022-12-31 | $0 |
| Other income received | 2022-12-31 | $-401,557 |
| Noncash contributions received | 2022-12-31 | $0 |
| Net income (gross income less expenses) | 2022-12-31 | $-401,557 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $2,690,598 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $3,092,155 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $0 |
| Value of certain deemed distributions of participant loans | 2022-12-31 | $0 |
| Value of corrective distributions | 2022-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $0 |
| 2021 : MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2021 401k financial data |
|---|
| Total income from all sources | 2021-12-31 | $-374,083 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $0 |
| Total plan assets at end of year | 2021-12-31 | $3,092,155 |
| Total plan assets at beginning of year | 2021-12-31 | $3,466,238 |
| Value of fidelity bond covering the plan | 2021-12-31 | $2,500,000 |
| Other income received | 2021-12-31 | $-374,083 |
| Net income (gross income less expenses) | 2021-12-31 | $-374,083 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $3,092,155 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $3,466,238 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2021-12-31 | $0 |
| 2020 : MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2020 401k financial data |
|---|
| Total income from all sources | 2020-12-31 | $31,331 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $120,046 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $120,010 |
| Total plan assets at end of year | 2020-12-31 | $3,466,238 |
| Total plan assets at beginning of year | 2020-12-31 | $3,554,953 |
| Value of fidelity bond covering the plan | 2020-12-31 | $250,000 |
| Other income received | 2020-12-31 | $31,331 |
| Net income (gross income less expenses) | 2020-12-31 | $-88,715 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $3,466,238 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $3,554,953 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $36 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2020-12-31 | $0 |
| 2019 : MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2019 401k financial data |
|---|
| Total income from all sources | 2019-12-31 | $22,497 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $20,193 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $20,184 |
| Total plan assets at end of year | 2019-12-31 | $3,554,953 |
| Total plan assets at beginning of year | 2019-12-31 | $3,552,649 |
| Value of fidelity bond covering the plan | 2019-12-31 | $355,265 |
| Total contributions received or receivable from participants | 2019-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2019-12-31 | $0 |
| Other income received | 2019-12-31 | $22,497 |
| Noncash contributions received | 2019-12-31 | $0 |
| Net income (gross income less expenses) | 2019-12-31 | $2,304 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $3,554,953 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $3,552,649 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $0 |
| Value of certain deemed distributions of participant loans | 2019-12-31 | $0 |
| Value of corrective distributions | 2019-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $9 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2019-12-31 | $0 |
| 2018 : MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2018 401k financial data |
|---|
| Total income from all sources | 2018-12-31 | $43,466 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $80,000 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $80,000 |
| Total plan assets at end of year | 2018-12-31 | $3,552,649 |
| Total plan assets at beginning of year | 2018-12-31 | $3,589,183 |
| Value of fidelity bond covering the plan | 2018-12-31 | $250,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2018-12-31 | $0 |
| Noncash contributions received | 2018-12-31 | $43,466 |
| Net income (gross income less expenses) | 2018-12-31 | $-36,534 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $3,552,649 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $3,589,183 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $0 |
| Value of certain deemed distributions of participant loans | 2018-12-31 | $0 |
| Value of corrective distributions | 2018-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $0 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2018-12-31 | $0 |
| 2017 : MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $1,020,799 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $150,118 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $150,000 |
| Total plan assets at end of year | 2017-12-31 | $3,589,183 |
| Total plan assets at beginning of year | 2017-12-31 | $2,718,502 |
| Value of fidelity bond covering the plan | 2017-12-31 | $250,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2017-12-31 | $0 |
| Other income received | 2017-12-31 | $1,020,799 |
| Net income (gross income less expenses) | 2017-12-31 | $870,681 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $3,589,183 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $2,718,502 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $0 |
| Value of certain deemed distributions of participant loans | 2017-12-31 | $0 |
| Value of corrective distributions | 2017-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $118 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2017-12-31 | $0 |
| 2022: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: MIEN DOOR KIOUNE, M.D. RETIREMENT PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 ) |
| Policy contract number | 40982100 |
| Policy instance | 1 |
| Insurance contract or identification number | 40982100 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 1 | | 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? | No | | 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 |
|
| NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 ) |
| Policy contract number | 40982100 |
| Policy instance | 1 |
| Insurance contract or identification number | 40982100 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Are there contracts with allocated funds for individual policies? | 1 | | 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? | No | | 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 |
|
| NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 ) |
| Policy contract number | 40982100 |
| Policy instance | 1 |
| Insurance contract or identification number | 40982100 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 1 | | 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? | No | | 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 |
|
| NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 ) |
| Policy contract number | 40982100 |
| Policy instance | 1 |
| Insurance contract or identification number | 40982100 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for individual policies? | 1 | | 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? | No | | 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 |
|
| NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 ) |
| Policy contract number | 40982100 |
| Policy instance | 1 |
| Insurance contract or identification number | 40982100 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Are there contracts with allocated funds for individual policies? | 1 | | 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? | No | | 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 |
|
| NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 ) |
| Policy contract number | 40982100 |
| Policy instance | 1 |
| Insurance contract or identification number | 40982100 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Are there contracts with allocated funds for individual policies? | 1 | | 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? | No | | 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 |
|
