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FIRST COMMUNITY BANK OF EASTERN ARKANSAS EMPLOYEE STOCK OWNERSHIP PLAN WITH 401K PROVISIONS 401k Plan overview

Plan NameFIRST COMMUNITY BANK OF EASTERN ARKANSAS EMPLOYEE STOCK OWNERSHIP PLAN WITH 401K PROVISIONS
Plan identification number 001

FIRST COMMUNITY BANK OF EASTERN ARKANSAS EMPLOYEE STOCK OWNERSHIP PLAN WITH 401K PROVISIONS Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    PREMIER BANK OF ARKANSAS has sponsored the creation of one or more 401k plans.

    Company Name:PREMIER BANK OF ARKANSAS
    Employer identification number (EIN):710810705
    NAIC Classification:522110
    NAIC Description:Commercial Banking

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan FIRST COMMUNITY BANK OF EASTERN ARKANSAS EMPLOYEE STOCK OWNERSHIP PLAN WITH 401K PROVISIONS

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    0012022-01-01
    0012021-01-01
    0012020-01-01
    0012020-01-01
    0012019-01-01
    0012017-01-01BRENDA H. ELDRIDGE
    0012016-01-01BRENDA H. ELDRIDGE
    0012015-01-01BRENDA H. ELDRIDGE
    0012014-01-01BRENDA H. ELDRIDGE BRENDA H. ELDRIDGE2015-06-22
    0012013-01-01BRENDA H. ELDRIDGE
    0012012-01-01BRENDA H. ELDRIDGE
    0012011-01-01BRENDA H. ELDRIDGE
    0012009-01-01BRENDA H. ELDRIDGE

    Plan Statistics for FIRST COMMUNITY BANK OF EASTERN ARKANSAS EMPLOYEE STOCK OWNERSHIP PLAN WITH 401K PROVISIONS

    401k plan membership statisitcs for FIRST COMMUNITY BANK OF EASTERN ARKANSAS EMPLOYEE STOCK OWNERSHIP PLAN WITH 401K PROVISIONS

    Measure Date Value
    2022
    Total participants, beginning-of-year2022-01-0149
    Total number of active participants reported on line 7a of the Form 55002022-01-010
    Number of retired or separated participants receiving benefits2022-01-010
    Number of other retired or separated participants entitled to future benefits2022-01-010
    Total of all active and inactive participants2022-01-010
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
    Total participants2022-01-010
    Number of participants with account balances2022-01-010
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
    2021
    Total participants, beginning-of-year2021-01-0150
    Total number of active participants reported on line 7a of the Form 55002021-01-0127
    Number of retired or separated participants receiving benefits2021-01-018
    Number of other retired or separated participants entitled to future benefits2021-01-0113
    Total of all active and inactive participants2021-01-0148
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
    Total participants2021-01-0148
    Number of participants with account balances2021-01-0137
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
    2020
    Total participants, beginning-of-year2020-01-0147
    Total number of active participants reported on line 7a of the Form 55002020-01-0132
    Number of retired or separated participants receiving benefits2020-01-017
    Number of other retired or separated participants entitled to future benefits2020-01-0110
    Total of all active and inactive participants2020-01-0149
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
    Total participants2020-01-0149
    Number of participants with account balances2020-01-0134
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
    2019
    Total participants, beginning-of-year2019-01-0141
    Total number of active participants reported on line 7a of the Form 55002019-01-0125
    Number of retired or separated participants receiving benefits2019-01-017
    Number of other retired or separated participants entitled to future benefits2019-01-0112
    Total of all active and inactive participants2019-01-0144
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
    Total participants2019-01-0144
    Number of participants with account balances2019-01-0132
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
    2017
    Total participants, beginning-of-year2017-01-0136
    Total number of active participants reported on line 7a of the Form 55002017-01-0127
    Number of retired or separated participants receiving benefits2017-01-014
    Number of other retired or separated participants entitled to future benefits2017-01-015
    Total of all active and inactive participants2017-01-0136
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
    Total participants2017-01-0136
    Number of participants with account balances2017-01-0125
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
    2016
    Total participants, beginning-of-year2016-01-0140
    Total number of active participants reported on line 7a of the Form 55002016-01-0127
    Number of retired or separated participants receiving benefits2016-01-014
    Number of other retired or separated participants entitled to future benefits2016-01-015
    Total of all active and inactive participants2016-01-0136
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
    Total participants2016-01-0136
    Number of participants with account balances2016-01-0124
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
    2015
    Total participants, beginning-of-year2015-01-0139
    Total number of active participants reported on line 7a of the Form 55002015-01-0131
    Number of retired or separated participants receiving benefits2015-01-012
    Number of other retired or separated participants entitled to future benefits2015-01-016
    Total of all active and inactive participants2015-01-0139
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
    Total participants2015-01-0139
    Number of participants with account balances2015-01-0126
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
    2014
    Total participants, beginning-of-year2014-01-0140
    Total number of active participants reported on line 7a of the Form 55002014-01-0133
    Number of retired or separated participants receiving benefits2014-01-010
    Number of other retired or separated participants entitled to future benefits2014-01-016
    Total of all active and inactive participants2014-01-0139
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
    Total participants2014-01-0139
    Number of participants with account balances2014-01-0126
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
    2013
    Total participants, beginning-of-year2013-01-0141
    Total number of active participants reported on line 7a of the Form 55002013-01-0135
    Number of retired or separated participants receiving benefits2013-01-011
    Number of other retired or separated participants entitled to future benefits2013-01-013
    Total of all active and inactive participants2013-01-0139
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
    Total participants2013-01-0139
    Number of participants with account balances2013-01-0127
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
    2012
    Total participants, beginning-of-year2012-01-0141
    Total number of active participants reported on line 7a of the Form 55002012-01-0138
    Number of retired or separated participants receiving benefits2012-01-011
    Number of other retired or separated participants entitled to future benefits2012-01-012
    Total of all active and inactive participants2012-01-0141
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
    Total participants2012-01-0141
    Number of participants with account balances2012-01-0124
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
    2011
    Total participants, beginning-of-year2011-01-0135
    Total number of active participants reported on line 7a of the Form 55002011-01-0138
    Number of retired or separated participants receiving benefits2011-01-010
    Number of other retired or separated participants entitled to future benefits2011-01-013
    Total of all active and inactive participants2011-01-0141
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
    Total participants2011-01-0141
    Number of participants with account balances2011-01-0124
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
    2009
    Total participants, beginning-of-year2009-01-0130
    Total number of active participants reported on line 7a of the Form 55002009-01-0131
    Number of retired or separated participants receiving benefits2009-01-010
    Number of other retired or separated participants entitled to future benefits2009-01-013
    Total of all active and inactive participants2009-01-0134
    Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
    Total participants2009-01-0134
    Number of participants with account balances2009-01-0123
    Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

    Financial Data on FIRST COMMUNITY BANK OF EASTERN ARKANSAS EMPLOYEE STOCK OWNERSHIP PLAN WITH 401K PROVISIONS

    Measure Date Value
    2022
    Total plan liabilities at end of year2022-05-31$0
    Total plan liabilities at beginning of year2022-05-31$1,127
    Total income from all sources2022-05-31$686,388
    Expenses. Total of all expenses incurred2022-05-31$3,622,724
    Benefits paid (including direct rollovers)2022-05-31$3,622,724
    Total plan assets at end of year2022-05-31$0
    Total plan assets at beginning of year2022-05-31$2,937,463
    Value of fidelity bond covering the plan2022-05-31$2,000,000
    Total contributions received or receivable from participants2022-05-31$64,749
    Other income received2022-05-31$580,841
    Net income (gross income less expenses)2022-05-31$-2,936,336
    Net plan assets at end of year (total assets less liabilities)2022-05-31$0
    Net plan assets at beginning of year (total assets less liabilities)2022-05-31$2,936,336
    Assets. Value of employer securities2022-05-31$0
    Total contributions received or receivable from employer(s)2022-05-31$40,798
    2021
    Total plan liabilities at end of year2021-12-31$1,127
    Total plan liabilities at beginning of year2021-12-31$3,009
    Total income from all sources2021-12-31$488,712
    Expenses. Total of all expenses incurred2021-12-31$92,597
    Benefits paid (including direct rollovers)2021-12-31$92,597
    Total plan assets at end of year2021-12-31$2,937,463
    Total plan assets at beginning of year2021-12-31$2,543,230
    Value of fidelity bond covering the plan2021-12-31$2,000,000
    Total contributions received or receivable from participants2021-12-31$109,727
    Other income received2021-12-31$314,197
    Net income (gross income less expenses)2021-12-31$396,115
    Net plan assets at end of year (total assets less liabilities)2021-12-31$2,936,336
    Net plan assets at beginning of year (total assets less liabilities)2021-12-31$2,540,221
    Assets. Value of employer securities2021-12-31$2,819,243
    Total contributions received or receivable from employer(s)2021-12-31$64,788
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$51,884
    2020
    Total plan liabilities at end of year2020-12-31$3,009
    Total plan liabilities at beginning of year2020-12-31$0
    Total income from all sources2020-12-31$337,850
    Expenses. Total of all expenses incurred2020-12-31$426,355
    Benefits paid (including direct rollovers)2020-12-31$426,355
    Total plan assets at end of year2020-12-31$2,619,530
    Total plan assets at beginning of year2020-12-31$2,705,026
    Value of fidelity bond covering the plan2020-12-31$2,000,000
    Total contributions received or receivable from participants2020-12-31$100,682
    Contributions received from other sources (not participants or employers)2020-12-31$0
    Other income received2020-12-31$175,584
    Net income (gross income less expenses)2020-12-31$-88,505
    Net plan assets at end of year (total assets less liabilities)2020-12-31$2,616,521
    Net plan assets at beginning of year (total assets less liabilities)2020-12-31$2,705,026
    Assets. Value of employer securities2020-12-31$2,503,948
    Total contributions received or receivable from employer(s)2020-12-31$61,584
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$69,768
    2019
    Total plan liabilities at end of year2019-12-31$0
    Total plan liabilities at beginning of year2019-12-31$10,000
    Total income from all sources2019-12-31$452,305
    Expenses. Total of all expenses incurred2019-12-31$54,081
    Benefits paid (including direct rollovers)2019-12-31$54,081
    Total plan assets at end of year2019-12-31$2,705,026
    Total plan assets at beginning of year2019-12-31$2,316,802
    Value of fidelity bond covering the plan2019-12-31$2,000,000
    Total contributions received or receivable from participants2019-12-31$61,969
    Other income received2019-12-31$353,358
    Net income (gross income less expenses)2019-12-31$398,224
    Net plan assets at end of year (total assets less liabilities)2019-12-31$2,705,026
    Net plan assets at beginning of year (total assets less liabilities)2019-12-31$2,306,802
    Assets. Value of employer securities2019-12-31$2,557,752
    Total contributions received or receivable from employer(s)2019-12-31$36,978
    Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$48,416
    2018
    Total plan liabilities at end of year2018-12-31$10,000
    Total plan liabilities at beginning of year2018-12-31$13,974
    Total income from all sources2018-12-31$169,456
    Expenses. Total of all expenses incurred2018-12-31$223,791
    Benefits paid (including direct rollovers)2018-12-31$223,791
    Total plan assets at end of year2018-12-31$2,316,802
    Total plan assets at beginning of year2018-12-31$2,375,111
    Value of fidelity bond covering the plan2018-12-31$2,000,000
    Total contributions received or receivable from participants2018-12-31$70,775
    Other income received2018-12-31$62,789
    Net income (gross income less expenses)2018-12-31$-54,335
    Net plan assets at end of year (total assets less liabilities)2018-12-31$2,306,802
    Net plan assets at beginning of year (total assets less liabilities)2018-12-31$2,361,137
    Assets. Value of employer securities2018-12-31$2,192,604
    Total contributions received or receivable from employer(s)2018-12-31$35,892
    2017
    Total plan liabilities at end of year2017-12-31$13,974
    Total plan liabilities at beginning of year2017-12-31$5,747
    Total income from all sources2017-12-31$279,724
    Expenses. Total of all expenses incurred2017-12-31$54,414
    Benefits paid (including direct rollovers)2017-12-31$54,414
    Total plan assets at end of year2017-12-31$2,375,111
    Total plan assets at beginning of year2017-12-31$2,141,574
    Value of fidelity bond covering the plan2017-12-31$2,000,000
    Total contributions received or receivable from participants2017-12-31$67,104
    Other income received2017-12-31$173,238
    Net income (gross income less expenses)2017-12-31$225,310
    Net plan assets at end of year (total assets less liabilities)2017-12-31$2,361,137
    Net plan assets at beginning of year (total assets less liabilities)2017-12-31$2,135,827
    Assets. Value of employer securities2017-12-31$2,202,288
    Total contributions received or receivable from employer(s)2017-12-31$39,382
    2016
    Total plan liabilities at end of year2016-12-31$5,747
    Total plan liabilities at beginning of year2016-12-31$4,391
    Total income from all sources2016-12-31$251,863
    Expenses. Total of all expenses incurred2016-12-31$123,210
    Benefits paid (including direct rollovers)2016-12-31$123,210
    Total plan assets at end of year2016-12-31$2,141,574
    Total plan assets at beginning of year2016-12-31$2,011,565
    Value of fidelity bond covering the plan2016-12-31$2,000,000
    Total contributions received or receivable from participants2016-12-31$57,871
    Other income received2016-12-31$156,604
    Net income (gross income less expenses)2016-12-31$128,653
    Net plan assets at end of year (total assets less liabilities)2016-12-31$2,135,827
    Net plan assets at beginning of year (total assets less liabilities)2016-12-31$2,007,174
    Assets. Value of employer securities2016-12-31$2,007,040
    Total contributions received or receivable from employer(s)2016-12-31$37,388
    2015
    Total plan liabilities at end of year2015-12-31$4,391
    Total plan liabilities at beginning of year2015-12-31$1,643
    Total income from all sources2015-12-31$203,152
    Expenses. Total of all expenses incurred2015-12-31$33,693
    Benefits paid (including direct rollovers)2015-12-31$33,693
    Total plan assets at end of year2015-12-31$2,011,565
    Total plan assets at beginning of year2015-12-31$1,839,358
    Value of fidelity bond covering the plan2015-12-31$2,000,000
    Total contributions received or receivable from participants2015-12-31$71,096
    Other income received2015-12-31$85,467
    Net income (gross income less expenses)2015-12-31$169,459
    Net plan assets at end of year (total assets less liabilities)2015-12-31$2,007,174
    Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,837,715
    Assets. Value of employer securities2015-12-31$1,889,514
    Total contributions received or receivable from employer(s)2015-12-31$46,589
    2014
    Total plan liabilities at end of year2014-12-31$1,643
    Total plan liabilities at beginning of year2014-12-31$1,137
    Total income from all sources2014-12-31$297,501
    Expenses. Total of all expenses incurred2014-12-31$20,433
    Benefits paid (including direct rollovers)2014-12-31$20,433
    Total plan assets at end of year2014-12-31$1,839,358
    Total plan assets at beginning of year2014-12-31$1,561,784
    Value of fidelity bond covering the plan2014-12-31$3,000,000
    Total contributions received or receivable from participants2014-12-31$73,953
    Other income received2014-12-31$175,857
    Net income (gross income less expenses)2014-12-31$277,068
    Net plan assets at end of year (total assets less liabilities)2014-12-31$1,837,715
    Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,560,647
    Assets. Value of employer securities2014-12-31$1,722,621
    Total contributions received or receivable from employer(s)2014-12-31$47,691
    2013
    Total plan liabilities at end of year2013-12-31$1,137
    Total plan liabilities at beginning of year2013-12-31$0
    Total income from all sources2013-12-31$229,458
    Expenses. Total of all expenses incurred2013-12-31$0
    Total plan assets at end of year2013-12-31$1,561,784
    Total plan assets at beginning of year2013-12-31$1,331,189
    Value of fidelity bond covering the plan2013-12-31$3,000,000
    Total contributions received or receivable from participants2013-12-31$72,960
    Contributions received from other sources (not participants or employers)2013-12-31$25,000
    Other income received2013-12-31$84,779
    Net income (gross income less expenses)2013-12-31$229,458
    Net plan assets at end of year (total assets less liabilities)2013-12-31$1,560,647
    Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,331,189
    Assets. Value of employer securities2013-12-31$1,464,210
    Total contributions received or receivable from employer(s)2013-12-31$46,719
    2012
    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$268,186
    Expenses. Total of all expenses incurred2012-12-31$2,628
    Benefits paid (including direct rollovers)2012-12-31$2,628
    Total plan assets at end of year2012-12-31$1,331,189
    Total plan assets at beginning of year2012-12-31$1,065,631
    Value of fidelity bond covering the plan2012-12-31$3,000,000
    Total contributions received or receivable from participants2012-12-31$73,350
    Contributions received from other sources (not participants or employers)2012-12-31$10,000
    Other income received2012-12-31$140,315
    Net income (gross income less expenses)2012-12-31$265,558
    Net plan assets at end of year (total assets less liabilities)2012-12-31$1,331,189
    Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,065,631
    Assets. Value of employer securities2012-12-31$1,276,965
    Total contributions received or receivable from employer(s)2012-12-31$44,521
    2011
    Total plan liabilities at end of year2011-12-31$0
    Total plan liabilities at beginning of year2011-12-31$204
    Total income from all sources2011-12-31$257,570
    Expenses. Total of all expenses incurred2011-12-31$0
    Total plan assets at end of year2011-12-31$1,065,631
    Total plan assets at beginning of year2011-12-31$808,265
    Value of fidelity bond covering the plan2011-12-31$3,000,000
    Total contributions received or receivable from participants2011-12-31$71,407
    Other income received2011-12-31$143,652
    Net income (gross income less expenses)2011-12-31$257,570
    Net plan assets at end of year (total assets less liabilities)2011-12-31$1,065,631
    Net plan assets at beginning of year (total assets less liabilities)2011-12-31$808,061
    Assets. Value of employer securities2011-12-31$1,039,647
    Total contributions received or receivable from employer(s)2011-12-31$42,511
    2010
    Total plan liabilities at end of year2010-12-31$204
    Total plan liabilities at beginning of year2010-12-31$236
    Total income from all sources2010-12-31$75,587
    Expenses. Total of all expenses incurred2010-12-31$54,103
    Benefits paid (including direct rollovers)2010-12-31$54,103
    Total plan assets at end of year2010-12-31$808,265
    Total plan assets at beginning of year2010-12-31$786,813
    Value of fidelity bond covering the plan2010-12-31$3,000,000
    Total contributions received or receivable from participants2010-12-31$64,835
    Other income received2010-12-31$-25,526
    Net income (gross income less expenses)2010-12-31$21,484
    Net plan assets at end of year (total assets less liabilities)2010-12-31$808,061
    Net plan assets at beginning of year (total assets less liabilities)2010-12-31$786,577
    Assets. Value of employer securities2010-12-31$795,872
    Total contributions received or receivable from employer(s)2010-12-31$36,278

    Form 5500 Responses

    2022
    2022-01-01Type of plan entitySingle employer plan
    2022-01-01Submission has been amendedNo
    2022-01-01This submission is the final filingYes
    2022-01-01This return/report is a short plan year return/report (less than 12 months)Yes
    2022-01-01Plan is a collectively bargained planNo
    2022-01-01Plan funding arrangement – InsuranceYes
    2022-01-01Plan funding arrangement – TrustYes
    2022-01-01Plan benefit arrangement – InsuranceYes
    2022-01-01Plan benefit arrangement - TrustYes
    2021
    2021-01-01Type of plan entitySingle employer plan
    2021-01-01Submission has been amendedNo
    2021-01-01This submission is the final filingNo
    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
    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
    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
    2017
    2017-01-01Type of plan entitySingle employer plan
    2017-01-01Submission has been amendedNo
    2017-01-01This submission is the final filingNo
    2017-01-01This return/report is a short plan year return/report (less than 12 months)No
    2017-01-01Plan is a collectively bargained planNo
    2017-01-01Plan funding arrangement – InsuranceYes
    2017-01-01Plan funding arrangement – TrustYes
    2017-01-01Plan benefit arrangement – InsuranceYes
    2017-01-01Plan benefit arrangement - TrustYes
    2016
    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
    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
    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
    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
    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
    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
    2009
    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 COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
    Policy contract numberGAP-52-DC25
    Policy instance 1
    Insurance contract or identification numberGAP-52-DC25
    Number of Individuals Covered11
    Insurance policy start date2022-01-01
    Insurance policy end date2022-05-31
    Total amount of commissions paid to insurance brokerUSD $392
    Total amount of fees paid to insurance companyUSD $98
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
    Commission paid to Insurance BrokerUSD $392
    Insurance broker organization code?7
    Amount paid for insurance broker fees98
    Additional information about fees paid to insurance brokerADMIN FEES
    NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
    Policy contract numberGAP-52-DC25
    Policy instance 1
    Insurance contract or identification numberGAP-52-DC25
    Number of Individuals Covered11
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $735
    Total amount of fees paid to insurance companyUSD $184
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
    Commission paid to Insurance BrokerUSD $735
    Insurance broker organization code?7
    Amount paid for insurance broker fees184
    Additional information about fees paid to insurance brokerADMIN FEES
    NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
    Policy contract numberGAP-52-DC25
    Policy instance 1
    Insurance contract or identification numberGAP-52-DC25
    Number of Individuals Covered13
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $854
    Total amount of fees paid to insurance companyUSD $213
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
    Commission paid to Insurance BrokerUSD $854
    Insurance broker organization code?7
    Amount paid for insurance broker fees213
    Additional information about fees paid to insurance brokerADMIN FEES
    NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
    Policy contract numberGAP-52-DC25
    Policy instance 1
    Insurance contract or identification numberGAP-52-DC25
    Number of Individuals Covered12
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $871
    Total amount of fees paid to insurance companyUSD $218
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
    Commission paid to Insurance BrokerUSD $871
    Insurance broker organization code?7
    Amount paid for insurance broker fees218
    Additional information about fees paid to insurance brokerADMIN FEES
    NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
    Policy contract numberGAP-52-DC25
    Policy instance 1
    Insurance contract or identification numberGAP-52-DC25
    Number of Individuals Covered9
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $958
    Total amount of fees paid to insurance companyUSD $240
    Are there contracts with allocated funds for individual policies?0
    Are there contracts with allocated funds for group deferred annuity?No
    Are there contracts with allocated funds for types other than group deferred annuity or individual?No
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
    Are there contracts with unallocated funds for contracts of type guaranteed investment?No
    Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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
    Commission paid to Insurance BrokerUSD $958
    Insurance broker organization code?7
    Amount paid for insurance broker fees240
    Additional information about fees paid to insurance brokerADMIN FEES
    Insurance broker nameBENEFIT RESOURCES, INC.
    NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
    Policy contract numberGAP-52-DC25
    Policy instance 1
    Insurance contract or identification numberGAP-52-DC25
    Number of Individuals Covered8
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $792
    Total amount of fees paid to insurance companyUSD $198
    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?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
    Commission paid to Insurance BrokerUSD $792
    Insurance broker organization code?7
    Amount paid for insurance broker fees198
    Additional information about fees paid to insurance brokerADMIN FEES
    Insurance broker nameBENEFIT RESOURCES, INC.
    NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
    Policy contract numberGAP-52-DC25
    Policy instance 1
    Insurance contract or identification numberGAP-52-DC25
    Number of Individuals Covered10
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $708
    Total amount of fees paid to insurance companyUSD $177
    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?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
    Commission paid to Insurance BrokerUSD $708
    Insurance broker organization code?7
    Amount paid for insurance broker fees177
    Additional information about fees paid to insurance brokerADMIN FEES
    Insurance broker nameBENEFIT RESOURCES, INC.
    NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
    Policy contract numberGAP-52-DC25
    Policy instance 1
    Insurance contract or identification numberGAP-52-DC25
    Number of Individuals Covered8
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $471
    Total amount of fees paid to insurance companyUSD $118
    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?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
    Commission paid to Insurance BrokerUSD $471
    Insurance broker organization code?7
    Amount paid for insurance broker fees118
    Additional information about fees paid to insurance brokerADMIN FEES
    Insurance broker nameBENEFIT RESOURCES, INC.
    NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
    Policy contract numberGAP-52-DC25
    Policy instance 1
    Insurance contract or identification numberGAP-52-DC25
    Number of Individuals Covered8
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $226
    Total amount of fees paid to insurance companyUSD $57
    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?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
    Commission paid to Insurance BrokerUSD $226
    Insurance broker organization code?7
    Amount paid for insurance broker fees57
    Additional information about fees paid to insurance brokerADMIN FEES
    Insurance broker nameBENEFIT RESOURCES, INC.
    NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
    Policy contract numberGAP52DC26
    Policy instance 1
    Insurance contract or identification numberGAP52DC26
    Number of Individuals Covered9
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $114
    Total amount of fees paid to insurance companyUSD $28
    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?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 COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
    Policy contract numberGAP52DC26
    Policy instance 1
    Insurance contract or identification numberGAP52DC26
    Number of Individuals Covered7
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $90
    Total amount of fees paid to insurance companyUSD $22
    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?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
    Commission paid to Insurance BrokerUSD $90
    Insurance broker organization code?7
    Amount paid for insurance broker fees22
    Additional information about fees paid to insurance brokerADMIN FEES
    Insurance broker nameBENEFIT RESOURCES, INC.

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