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DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 401k Plan overview

Plan NameDALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN
Plan identification number 001

DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Money purchase (other than target benefit)
  • 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.
  • Partial participant-directed account plan - Participants have the opportunity to direct the investment of a portion of 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.
  • 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.
  • Life insurance

401k Sponsoring company profile

DALE A. TEAGUE, M.D., P.C. has sponsored the creation of one or more 401k plans.

Company Name:DALE A. TEAGUE, M.D., P.C.
Employer identification number (EIN):620817198
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012015-01-01DALE TEAGUE
0012015-01-01DALE TEAGUE
0012014-01-01DALE TEAGUE
0012013-01-01DALE TEAGUE
0012012-01-01DALE TEAGUE
0012011-01-01DALE TEAGUE
0012010-01-01DALE TEAGUE
0012009-01-01DALE TEAGUE

Plan Statistics for DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN

401k plan membership statisitcs for DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN

Measure Date Value
2015: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-013
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-010
Number of participants with account balances2015-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-013
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-012
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-012
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-012
Number of participants with account balances2014-01-012
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-013
Total number of active participants reported on line 7a of the Form 55002013-01-013
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-013
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-013
Number of participants with account balances2013-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-013
Total number of active participants reported on line 7a of the Form 55002012-01-013
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-013
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-013
Number of participants with account balances2012-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-013
Total number of active participants reported on line 7a of the Form 55002011-01-013
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-013
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-013
Number of participants with account balances2011-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-013
Total number of active participants reported on line 7a of the Form 55002010-01-013
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-013
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-013
Number of participants with account balances2010-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-013
Total number of active participants reported on line 7a of the Form 55002009-01-013
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-013
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-013
Number of participants with account balances2009-01-013
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN

Measure Date Value
2015 : DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2015 401k financial data
Total income from all sources2015-12-31$-3,308
Expenses. Total of all expenses incurred2015-12-31$1,713,024
Benefits paid (including direct rollovers)2015-12-31$1,700,050
Total plan assets at end of year2015-12-31$0
Total plan assets at beginning of year2015-12-31$1,716,332
Value of fidelity bond covering the plan2015-12-31$400,000
Expenses. Other expenses not covered elsewhere2015-12-31$12,974
Other income received2015-12-31$-3,308
Net income (gross income less expenses)2015-12-31$-1,716,332
Net plan assets at end of year (total assets less liabilities)2015-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,716,332
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Minimum employer required contribution for this plan year2015-12-31$0
2014 : DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2014 401k financial data
Total income from all sources2014-12-31$74,510
Expenses. Total of all expenses incurred2014-12-31$342,971
Benefits paid (including direct rollovers)2014-12-31$328,387
Total plan assets at end of year2014-12-31$1,716,332
Total plan assets at beginning of year2014-12-31$1,984,793
Value of fidelity bond covering the plan2014-12-31$400,000
Other income received2014-12-31$74,510
Net income (gross income less expenses)2014-12-31$-268,461
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,716,332
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,984,793
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$14,584
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Funding deficiency by the employer to the plan for this plan year2014-12-31$0
Minimum employer required contribution for this plan year2014-12-31$0
Amount contributed by the employer to the plan for this plan year2014-12-31$0
2013 : DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2013 401k financial data
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$196,064
Expenses. Total of all expenses incurred2013-12-31$131,056
Benefits paid (including direct rollovers)2013-12-31$117,304
Total plan assets at end of year2013-12-31$1,984,793
Total plan assets at beginning of year2013-12-31$1,919,785
Value of fidelity bond covering the plan2013-12-31$400,000
Expenses. Other expenses not covered elsewhere2013-12-31$960
Contributions received from other sources (not participants or employers)2013-12-31$729
Other income received2013-12-31$195,335
Net income (gross income less expenses)2013-12-31$65,008
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,984,793
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,919,785
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$12,792
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
Funding deficiency by the employer to the plan for this plan year2013-12-31$0
Minimum employer required contribution for this plan year2013-12-31$0
Amount contributed by the employer to the plan for this plan year2013-12-31$0
2012 : DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2012 401k financial data
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$0
Total income from all sources2012-12-31$243,162
Expenses. Total of all expenses incurred2012-12-31$183,714
Benefits paid (including direct rollovers)2012-12-31$167,283
Total plan assets at end of year2012-12-31$1,919,785
Total plan assets at beginning of year2012-12-31$1,860,337
Value of fidelity bond covering the plan2012-12-31$400,000
Expenses. Other expenses not covered elsewhere2012-12-31$16,431
Other income received2012-12-31$243,162
Net income (gross income less expenses)2012-12-31$59,448
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,919,785
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,860,337
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
Funding deficiency by the employer to the plan for this plan year2012-12-31$0
Minimum employer required contribution for this plan year2012-12-31$0
Amount contributed by the employer to the plan for this plan year2012-12-31$0
2011 : DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2011 401k financial data
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$12,559
Expenses. Total of all expenses incurred2011-12-31$179,577
Benefits paid (including direct rollovers)2011-12-31$167,508
Total plan assets at end of year2011-12-31$1,860,337
Total plan assets at beginning of year2011-12-31$2,027,355
Value of fidelity bond covering the plan2011-12-31$400,000
Expenses. Other expenses not covered elsewhere2011-12-31$12,069
Other income received2011-12-31$12,559
Net income (gross income less expenses)2011-12-31$-167,018
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,860,337
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$2,027,355
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Funding deficiency by the employer to the plan for this plan year2011-12-31$0
Minimum employer required contribution for this plan year2011-12-31$0
Amount contributed by the employer to the plan for this plan year2011-12-31$0
2010 : DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2010 401k financial data
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$160,378
Expenses. Total of all expenses incurred2010-12-31$255,857
Benefits paid (including direct rollovers)2010-12-31$243,055
Total plan assets at end of year2010-12-31$2,027,355
Total plan assets at beginning of year2010-12-31$2,122,834
Value of fidelity bond covering the plan2010-12-31$400,000
Assets. Value of loans (other than to participants)2010-12-31$1,232
Expenses. Other expenses not covered elsewhere2010-12-31$12,802
Other income received2010-12-31$160,378
Net income (gross income less expenses)2010-12-31$-95,479
Net plan assets at end of year (total assets less liabilities)2010-12-31$2,027,355
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$2,122,834
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Funding deficiency by the employer to the plan for this plan year2010-12-31$0
Minimum employer required contribution for this plan year2010-12-31$0
Amount contributed by the employer to the plan for this plan year2010-12-31$0
2009 : DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION 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
Funding deficiency by the employer to the plan for this plan year2009-12-31$0
Minimum employer required contribution for this plan year2009-12-31$0
Amount contributed by the employer to the plan for this plan year2009-12-31$0

Form 5500 Responses for DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN

2015: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION 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: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION 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
2013: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION 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 – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: DALE A. TEAGUE, M.D., P.C. EMPLOYEE MONEY PURCHASE PENSION 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 – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 )
Policy contract number2254747
Policy instance 1
Insurance contract or identification number2254747
Number of Individuals Covered0
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?Yes
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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
NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 )
Policy contract number2254747
Policy instance 1
Insurance contract or identification number2254747
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?Yes
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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
NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 )
Policy contract number2254747
Policy instance 1
Insurance contract or identification number2254747
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Are there contracts with allocated funds for individual policies?Yes
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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
NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 )
Policy contract number2254747
Policy instance 1
Insurance contract or identification number2254747
Number of Individuals Covered1
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Are there contracts with allocated funds for individual policies?Yes
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?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
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
NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 )
Policy contract number2254747
Policy instance 1
Insurance contract or identification number2254747
Number of Individuals Covered1
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
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?Yes
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?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
NATIONWIDE LIFE INSURANCE CO. OF AMERICA (National Association of Insurance Commissioners NAIC id number: 25453 )
Policy contract number2254747
Policy instance 1
Insurance contract or identification number2254747
Number of Individuals Covered1
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
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?Yes
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?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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