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GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN 401k Plan overview

Plan NameGREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN
Plan identification number 003

GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION 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.
  • 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

FORT WASHINGTON MEDICAL CENTER has sponsored the creation of one or more 401k plans.

Company Name:FORT WASHINGTON MEDICAL CENTER
Employer identification number (EIN):521682858
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032021-01-01
0032020-01-01
0032019-01-01
0032018-01-01
0032018-01-01

Plan Statistics for GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN

401k plan membership statisitcs for GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN

Measure Date Value
2021: GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01118
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-010
Number of participants with account balances2021-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01145
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-012
Number of other retired or separated participants entitled to future benefits2020-01-01116
Total of all active and inactive participants2020-01-01118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01118
Number of participants with account balances2020-01-01118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01150
Total number of active participants reported on line 7a of the Form 55002019-01-019
Number of retired or separated participants receiving benefits2019-01-012
Number of other retired or separated participants entitled to future benefits2019-01-01134
Total of all active and inactive participants2019-01-01145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01145
Number of participants with account balances2019-01-01145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01152
Total number of active participants reported on line 7a of the Form 55002018-01-0110
Number of retired or separated participants receiving benefits2018-01-012
Number of other retired or separated participants entitled to future benefits2018-01-01138
Total of all active and inactive participants2018-01-01150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01150
Number of participants with account balances2018-01-01150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010

Financial Data on GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN

Measure Date Value
2021 : GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$24,207
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$1,063,921
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,055,660
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$0
Value of total assets at end of year2021-12-31$0
Value of total assets at beginning of year2021-12-31$1,039,714
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$8,261
Total interest from all sources2021-12-31$857
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$44
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2021-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$44
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$1,000,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Other income not declared elsewhere2021-12-31$0
Administrative expenses (other) incurred2021-12-31$8,261
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-1,039,714
Value of net assets at end of year (total assets less liabilities)2021-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,039,714
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$128,467
Value of interest in pooled separate accounts at end of year2021-12-31$0
Value of interest in pooled separate accounts at beginning of year2021-12-31$712,752
Interest earned on other investments2021-12-31$857
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$198,495
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$5,265
Net investment gain/loss from pooled separate accounts2021-12-31$18,041
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,055,660
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31Yes
Opinion of an independent qualified public accountant for this plan2021-12-31Disclaimer
Accountancy firm name2021-12-31DIXON HUGHES GOODMAN LLP
Accountancy firm EIN2021-12-31560747981
2020 : GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$77,513
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$257,522
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$246,020
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$0
Value of total assets at end of year2020-12-31$1,039,714
Value of total assets at beginning of year2020-12-31$1,219,723
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$11,502
Total interest from all sources2020-12-31$6,727
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$1,195
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2020-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$1,195
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$1,000,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Other income not declared elsewhere2020-12-31$-1
Administrative expenses (other) incurred2020-12-31$11,502
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-180,009
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,039,714
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$1,219,723
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$128,467
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$122,902
Value of interest in pooled separate accounts at end of year2020-12-31$712,752
Value of interest in pooled separate accounts at beginning of year2020-12-31$718,261
Interest earned on other investments2020-12-31$6,727
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$198,495
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$378,560
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$12,786
Net investment gain/loss from pooled separate accounts2020-12-31$56,806
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$246,020
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31DIXON HUGHES GOODMAN LLP
Accountancy firm EIN2020-12-31560747981
2019 : GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$125,526
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$132,991
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$132,892
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$0
Value of total assets at end of year2019-12-31$1,219,723
Value of total assets at beginning of year2019-12-31$1,227,188
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$99
Total interest from all sources2019-12-31$11,161
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$1,925
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$1,925
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$1,000,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Other income not declared elsewhere2019-12-31$203
Administrative expenses (other) incurred2019-12-31$99
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-7,465
Value of net assets at end of year (total assets less liabilities)2019-12-31$1,219,723
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$1,227,188
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$122,902
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$136,539
Value of interest in pooled separate accounts at end of year2019-12-31$718,261
Value of interest in pooled separate accounts at beginning of year2019-12-31$712,288
Interest earned on other investments2019-12-31$11,161
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$378,560
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$378,361
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$28,030
Net investment gain/loss from pooled separate accounts2019-12-31$84,207
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$132,892
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31DIXON HUGHES GOODMAN LLP
Accountancy firm EIN2019-12-31560747981
2018 : GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION 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$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$-19,061
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$21,485
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$13,277
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$0
Value of total assets at end of year2018-12-31$1,227,188
Value of total assets at beginning of year2018-12-31$1,267,734
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$8,208
Total interest from all sources2018-12-31$11,147
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$2,030
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2018-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$2,030
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$1,000,000
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
Administrative expenses (other) incurred2018-12-31$8,208
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-40,546
Value of net assets at end of year (total assets less liabilities)2018-12-31$1,227,188
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$1,267,734
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$136,539
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$151,725
Value of interest in pooled separate accounts at end of year2018-12-31$712,288
Value of interest in pooled separate accounts at beginning of year2018-12-31$728,346
Interest earned on other investments2018-12-31$11,147
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$378,361
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$387,663
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-16,994
Net investment gain/loss from pooled separate accounts2018-12-31$-15,244
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$13,277
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)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31DIXON HUGHES GOODMAN LLP
Accountancy firm EIN2018-12-31560747981

Form 5500 Responses for GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN

2021: GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingYes
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: GREATER SOUTHEAST HEALTHCARE SYSTEM DEFINED CONTRIBUTION 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

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number314962
Policy instance 1
Insurance contract or identification number314962
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number314962
Policy instance 1
Insurance contract or identification number314962
Number of Individuals Covered118
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,808
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1808
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker organization code?4
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number314962
Policy instance 1
Insurance contract or identification number314962
Number of Individuals Covered145
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,204
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2204
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker organization code?4
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number314962
Policy instance 1
Insurance contract or identification number314962
Number of Individuals Covered150
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,228
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2228
Additional information about fees paid to insurance brokerSERVICES TO INSURER OR PLAN
Insurance broker organization code?4

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