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CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 401k Plan overview

Plan NameCLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN
Plan identification number 001

CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • 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.

401k Sponsoring company profile

CLIVE RUNNELLS ENTERPRISES has sponsored the creation of one or more 401k plans.

Company Name:CLIVE RUNNELLS ENTERPRISES
Employer identification number (EIN):741331884
NAIC Classification:812990
NAIC Description:All Other Personal Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012018-01-01PATTI YOUNG2019-07-10
0012017-01-01BEVERLY BARNETT2018-06-14
0012016-01-01BEVERLY K. BARNETT
0012015-01-01BEVERLY K. BARNETT
0012014-01-01BEVERLY BARNETT BEVERLY BARNETT2015-08-06
0012013-01-01CLIVE RUNNELLS CLIVE RUNNELLS2014-04-09
0012012-01-01CLIVE RUNNELLS CLIVE RUNNELLS2013-07-12
0012011-01-01CLIVE RUNNELLS CLIVE RUNNELLS2012-07-24
0012009-01-01
0012009-01-01CLIVE RUNNELLS

Plan Statistics for CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN

401k plan membership statisitcs for CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN

Measure Date Value
2016: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-018
Total number of active participants reported on line 7a of the Form 55002016-01-016
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-012
Total of all active and inactive participants2016-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-018
Number of participants with account balances2016-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-018
Total number of active participants reported on line 7a of the Form 55002015-01-017
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-011
Total of all active and inactive participants2015-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-018
Number of participants with account balances2015-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-019
Total number of active participants reported on line 7a of the Form 55002014-01-017
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-011
Total of all active and inactive participants2014-01-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-018
Number of participants with account balances2014-01-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-019
Total number of active participants reported on line 7a of the Form 55002013-01-017
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-012
Total of all active and inactive participants2013-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-019
Number of participants with account balances2013-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0111
Total number of active participants reported on line 7a of the Form 55002012-01-017
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-012
Total of all active and inactive participants2012-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-019
Number of participants with account balances2012-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-011
2011: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0111
Total number of active participants reported on line 7a of the Form 55002011-01-018
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 participants2011-01-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0111
Number of participants with account balances2011-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0112
Total number of active participants reported on line 7a of the Form 55002009-01-019
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-011
Total of all active and inactive participants2009-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-012
Total participants2009-01-0112
Number of participants with account balances2009-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN

Measure Date Value
2016 : CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2016 401k financial data
Transfers to/from the plan2016-12-31$0
Total plan liabilities at end of year2016-12-31$0
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$171,391
Expenses. Total of all expenses incurred2016-12-31$41,500
Benefits paid (including direct rollovers)2016-12-31$41,500
Total plan assets at end of year2016-12-31$1,322,181
Total plan assets at beginning of year2016-12-31$1,192,290
Value of fidelity bond covering the plan2016-12-31$100,000
Total contributions received or receivable from participants2016-12-31$72,664
Expenses. Other expenses not covered elsewhere2016-12-31$0
Contributions received from other sources (not participants or employers)2016-12-31$0
Other income received2016-12-31$67,052
Noncash contributions received2016-12-31$0
Net income (gross income less expenses)2016-12-31$129,891
Net plan assets at end of year (total assets less liabilities)2016-12-31$1,322,181
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,192,290
Assets. Value of participant loans2016-12-31$19,135
Total contributions received or receivable from employer(s)2016-12-31$31,675
Value of certain deemed distributions of participant loans2016-12-31$0
Value of corrective distributions2016-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan2015-12-31$0
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$0
Total income from all sources2015-12-31$117,914
Expenses. Total of all expenses incurred2015-12-31$0
Benefits paid (including direct rollovers)2015-12-31$0
Total plan assets at end of year2015-12-31$1,192,290
Total plan assets at beginning of year2015-12-31$1,074,376
Value of fidelity bond covering the plan2015-12-31$100,000
Total contributions received or receivable from participants2015-12-31$70,239
Expenses. Other expenses not covered elsewhere2015-12-31$0
Contributions received from other sources (not participants or employers)2015-12-31$0
Other income received2015-12-31$13,460
Noncash contributions received2015-12-31$0
Net income (gross income less expenses)2015-12-31$117,914
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,192,290
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,074,376
Assets. Value of participant loans2015-12-31$15,461
Total contributions received or receivable from employer(s)2015-12-31$34,215
Value of certain deemed distributions of participant loans2015-12-31$0
Value of corrective distributions2015-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$176,651
Expenses. Total of all expenses incurred2014-12-31$5,681
Benefits paid (including direct rollovers)2014-12-31$2,720
Total plan assets at end of year2014-12-31$1,074,376
Total plan assets at beginning of year2014-12-31$903,406
Value of fidelity bond covering the plan2014-12-31$100,000
Total contributions received or receivable from participants2014-12-31$62,809
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$82,112
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$170,970
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,074,376
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$903,406
Assets. Value of participant loans2014-12-31$21,177
Total contributions received or receivable from employer(s)2014-12-31$31,730
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$2,961
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2013 401k financial data
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$257,973
Expenses. Total of all expenses incurred2013-12-31$0
Benefits paid (including direct rollovers)2013-12-31$0
Total plan assets at end of year2013-12-31$903,406
Total plan assets at beginning of year2013-12-31$645,433
Value of fidelity bond covering the plan2013-12-31$100,000
Total contributions received or receivable from participants2013-12-31$55,840
Expenses. Other expenses not covered elsewhere2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$174,890
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$257,973
Net plan assets at end of year (total assets less liabilities)2013-12-31$903,406
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$645,433
Assets. Value of participant loans2013-12-31$14,765
Total contributions received or receivable from employer(s)2013-12-31$27,243
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-12-31$152,419
Expenses. Total of all expenses incurred2012-12-31$132,171
Benefits paid (including direct rollovers)2012-12-31$132,171
Total plan assets at end of year2012-12-31$645,433
Total plan assets at beginning of year2012-12-31$625,185
Value of fidelity bond covering the plan2012-12-31$100,000
Total contributions received or receivable from participants2012-12-31$43,872
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$83,794
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$20,248
Net plan assets at end of year (total assets less liabilities)2012-12-31$645,433
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$625,185
Assets. Value of participant loans2012-12-31$5,541
Total contributions received or receivable from employer(s)2012-12-31$24,753
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$49,935
Expenses. Total of all expenses incurred2011-12-31$5,783
Benefits paid (including direct rollovers)2011-12-31$5,783
Total plan assets at end of year2011-12-31$625,185
Total plan assets at beginning of year2011-12-31$581,033
Value of fidelity bond covering the plan2011-12-31$100,000
Total contributions received or receivable from participants2011-12-31$36,713
Expenses. Other expenses not covered elsewhere2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-9,175
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$44,152
Net plan assets at end of year (total assets less liabilities)2011-12-31$625,185
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$581,033
Assets. Value of participant loans2011-12-31$8,361
Total contributions received or receivable from employer(s)2011-12-31$22,397
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources2010-12-31$114,588
Expenses. Total of all expenses incurred2010-12-31$205
Benefits paid (including direct rollovers)2010-12-31$205
Total plan assets at end of year2010-12-31$581,033
Total plan assets at beginning of year2010-12-31$466,650
Value of fidelity bond covering the plan2010-12-31$100,000
Total contributions received or receivable from participants2010-12-31$26,950
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$62,362
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$114,383
Net plan assets at end of year (total assets less liabilities)2010-12-31$581,033
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$466,650
Assets. Value of participant loans2010-12-31$10,908
Total contributions received or receivable from employer(s)2010-12-31$25,276
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN

2016: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
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: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
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: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING 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: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING 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: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING 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: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING 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
2009: CLIVE RUNNELLS ENTERPRISES PROFIT SHARING 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 COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-50-T169
Policy instance 1
Insurance contract or identification numberGAP-50-T169
Number of Individuals Covered8
Total amount of commissions paid to insurance brokerUSD $4,819
Total amount of fees paid to insurance companyUSD $905
Commission paid to Insurance BrokerUSD $4,819
Insurance broker organization code?4
Amount paid for insurance broker fees905
Insurance broker nameJOHN OSBORNE
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-50-T169
Policy instance 1
Insurance contract or identification numberGAP-50-T169
Number of Individuals Covered8
Total amount of commissions paid to insurance brokerUSD $5,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,456
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?4
Insurance broker nameJOHN OSBORNE
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-50-T169
Policy instance 1
Insurance contract or identification numberGAP-50-T169
Number of Individuals Covered8
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,790
Total amount of fees paid to insurance companyUSD $648
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 $103
Amount paid for insurance broker fees648
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?7
Insurance broker nameIMS SECURITIES, INC.
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-50-T169
Policy instance 1
Insurance contract or identification numberGAP-50-T169
Number of Individuals Covered9
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,979
Total amount of fees paid to insurance companyUSD $445
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 $2,979
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?4
Amount paid for insurance broker fees445
Insurance broker nameJOHN OSBORN
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-50-T169
Policy instance 1
Insurance contract or identification numberGAP-50-T169
Number of Individuals Covered9
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,326
Total amount of fees paid to insurance companyUSD $392
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 $2,326
Amount paid for insurance broker fees392
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?4
Insurance broker nameIMS SECURITIES, INC.
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-50-T169
Policy instance 1
Insurance contract or identification numberGAP-50-T169
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,683
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?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 numberGAP-50-T169
Policy instance 1
Insurance contract or identification numberGAP-50-T169
Number of Individuals Covered11
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,924
Total amount of fees paid to insurance companyUSD $82
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 $1,924
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Amount paid for insurance broker fees82
Insurance broker nameJOHN OSBORN

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