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CAM ENVIRONMENTAL 401(K) PLAN 401k Plan overview

Plan NameCAM ENVIRONMENTAL 401(K) PLAN
Plan identification number 001

CAM ENVIRONMENTAL 401(K) 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

CAM ENVIRONMENTAL SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:CAM ENVIRONMENTAL SERVICES, INC.
Employer identification number (EIN):760641388
NAIC Classification:541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAM ENVIRONMENTAL 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012017-01-01EDWARD KEENAN
0012016-01-01EDWARD KEENAN
0012015-01-01EDWARD KEENAN
0012014-01-01EDWARD KEENAN EDWARD KEENAN2015-02-16
0012013-01-01EDWARD J. KEENAN EDWARD J. KEENAN2014-04-09
0012012-01-01EDWARD J. KEENAN EDWARD J. KEENAN2013-04-23
0012011-01-01EDWARD J. KEENAN EDWARD J. KEENAN2012-08-03
0012010-01-01EDWARD J. KEENAN EDWARD J. KEENAN2011-04-27
0012009-01-01EDWARD J. KEENAN EDWARD J. KEENAN2010-10-13
0012009-01-01EDWARD J. KEENAN EDWARD J. KEENAN2010-10-14

Plan Statistics for CAM ENVIRONMENTAL 401(K) PLAN

401k plan membership statisitcs for CAM ENVIRONMENTAL 401(K) PLAN

Measure Date Value
2017: CAM ENVIRONMENTAL 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-017
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-010
Number of participants with account balances2017-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: CAM ENVIRONMENTAL 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-017
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-017
Total of all active and inactive participants2016-01-017
Total participants2016-01-017
Number of participants with account balances2016-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: CAM ENVIRONMENTAL 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0193
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-012
Number of other retired or separated participants entitled to future benefits2015-01-015
Total of all active and inactive participants2015-01-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-017
Number of participants with account balances2015-01-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: CAM ENVIRONMENTAL 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0196
Total number of active participants reported on line 7a of the Form 55002014-01-0171
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0112
Total of all active and inactive participants2014-01-0183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0183
Number of participants with account balances2014-01-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: CAM ENVIRONMENTAL 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0180
Total number of active participants reported on line 7a of the Form 55002013-01-0178
Number of retired or separated participants receiving benefits2013-01-012
Number of other retired or separated participants entitled to future benefits2013-01-0112
Total of all active and inactive participants2013-01-0192
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0192
Number of participants with account balances2013-01-0150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: CAM ENVIRONMENTAL 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0188
Total number of active participants reported on line 7a of the Form 55002012-01-0158
Number of retired or separated participants receiving benefits2012-01-011
Number of other retired or separated participants entitled to future benefits2012-01-0113
Total of all active and inactive participants2012-01-0172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0172
Number of participants with account balances2012-01-0139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: CAM ENVIRONMENTAL 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0187
Total number of active participants reported on line 7a of the Form 55002011-01-0171
Number of retired or separated participants receiving benefits2011-01-011
Number of other retired or separated participants entitled to future benefits2011-01-018
Total of all active and inactive participants2011-01-0180
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0180
Number of participants with account balances2011-01-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: CAM ENVIRONMENTAL 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01107
Total number of active participants reported on line 7a of the Form 55002010-01-0173
Number of retired or separated participants receiving benefits2010-01-012
Number of other retired or separated participants entitled to future benefits2010-01-019
Total of all active and inactive participants2010-01-0184
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0184
Number of participants with account balances2010-01-0143
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: CAM ENVIRONMENTAL 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01105
Total number of active participants reported on line 7a of the Form 55002009-01-0178
Number of retired or separated participants receiving benefits2009-01-016
Number of other retired or separated participants entitled to future benefits2009-01-0121
Total of all active and inactive participants2009-01-01105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01105
Number of participants with account balances2009-01-0160
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on CAM ENVIRONMENTAL 401(K) PLAN

Measure Date Value
2017 : CAM ENVIRONMENTAL 401(K) PLAN 2017 401k financial data
Transfers to/from the plan2017-12-31$0
Total plan liabilities at end of year2017-12-31$0
Total income from all sources2017-12-31$0
Expenses. Total of all expenses incurred2017-12-31$70,459
Benefits paid (including direct rollovers)2017-12-31$70,459
Total plan assets at end of year2017-12-31$0
Total plan assets at beginning of year2017-12-31$70,459
Total contributions received or receivable from participants2017-12-31$0
Expenses. Other expenses not covered elsewhere2017-12-31$0
Contributions received from other sources (not participants or employers)2017-12-31$0
Other income received2017-12-31$0
Noncash contributions received2017-12-31$0
Net income (gross income less expenses)2017-12-31$-70,459
Net plan assets at end of year (total assets less liabilities)2017-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$70,459
Total contributions received or receivable from employer(s)2017-12-31$0
Value of certain deemed distributions of participant loans2017-12-31$0
Value of corrective distributions2017-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$0
2016 : CAM ENVIRONMENTAL 401(K) PLAN 2016 401k financial data
Transfers to/from the plan2016-12-31$0
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$0
Expenses. Total of all expenses incurred2016-12-31$0
Benefits paid (including direct rollovers)2016-12-31$0
Total plan assets at end of year2016-12-31$70,459
Total plan assets at beginning of year2016-12-31$70,459
Total contributions received or receivable from participants2016-12-31$0
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$0
Noncash contributions received2016-12-31$0
Net income (gross income less expenses)2016-12-31$0
Net plan assets at end of year (total assets less liabilities)2016-12-31$70,459
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$70,459
Total contributions received or receivable from employer(s)2016-12-31$0
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
2015 : CAM ENVIRONMENTAL 401(K) 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$13,250
Expenses. Total of all expenses incurred2015-12-31$794,508
Benefits paid (including direct rollovers)2015-12-31$661,111
Total plan assets at end of year2015-12-31$70,459
Total plan assets at beginning of year2015-12-31$851,717
Total contributions received or receivable from participants2015-12-31$1,899
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$11,351
Noncash contributions received2015-12-31$0
Net income (gross income less expenses)2015-12-31$-781,258
Net plan assets at end of year (total assets less liabilities)2015-12-31$70,459
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$851,717
Total contributions received or receivable from employer(s)2015-12-31$0
Value of certain deemed distributions of participant loans2015-12-31$126,887
Value of corrective distributions2015-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$6,510
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : CAM ENVIRONMENTAL 401(K) 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$121,818
Expenses. Total of all expenses incurred2014-12-31$57,606
Benefits paid (including direct rollovers)2014-12-31$57,606
Total plan assets at end of year2014-12-31$851,717
Total plan assets at beginning of year2014-12-31$787,505
Value of fidelity bond covering the plan2014-12-31$250,000
Total contributions received or receivable from participants2014-12-31$81,001
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$40,817
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$64,212
Net plan assets at end of year (total assets less liabilities)2014-12-31$851,717
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$787,505
Assets. Value of participant loans2014-12-31$127,519
Total contributions received or receivable from employer(s)2014-12-31$0
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
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 : CAM ENVIRONMENTAL 401(K) PLAN 2013 401k financial data
Total income from all sources2013-12-31$215,786
Expenses. Total of all expenses incurred2013-12-31$19,201
Benefits paid (including direct rollovers)2013-12-31$18,635
Total plan assets at end of year2013-12-31$787,505
Total plan assets at beginning of year2013-12-31$590,920
Value of fidelity bond covering the plan2013-12-31$250,000
Total contributions received or receivable from participants2013-12-31$77,779
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$138,007
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$196,585
Net plan assets at end of year (total assets less liabilities)2013-12-31$787,505
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$590,920
Assets. Value of participant loans2013-12-31$110,234
Total contributions received or receivable from employer(s)2013-12-31$0
Value of certain deemed distributions of participant loans2013-12-31$566
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 : CAM ENVIRONMENTAL 401(K) PLAN 2012 401k financial data
Total income from all sources2012-12-31$113,863
Expenses. Total of all expenses incurred2012-12-31$26,706
Benefits paid (including direct rollovers)2012-12-31$26,706
Total plan assets at end of year2012-12-31$590,920
Total plan assets at beginning of year2012-12-31$503,763
Value of fidelity bond covering the plan2012-12-31$250,000
Total contributions received or receivable from participants2012-12-31$59,843
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$54,020
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$87,157
Net plan assets at end of year (total assets less liabilities)2012-12-31$590,920
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$503,763
Assets. Value of participant loans2012-12-31$65,532
Total contributions received or receivable from employer(s)2012-12-31$0
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 : CAM ENVIRONMENTAL 401(K) PLAN 2011 401k financial data
Total income from all sources2011-12-31$42,432
Expenses. Total of all expenses incurred2011-12-31$26,952
Benefits paid (including direct rollovers)2011-12-31$24,174
Total plan assets at end of year2011-12-31$503,763
Total plan assets at beginning of year2011-12-31$488,283
Value of fidelity bond covering the plan2011-12-31$250,000
Total contributions received or receivable from participants2011-12-31$67,276
Expenses. Other expenses not covered elsewhere2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-24,844
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$15,480
Net plan assets at end of year (total assets less liabilities)2011-12-31$503,763
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$488,283
Assets. Value of participant loans2011-12-31$27,360
Total contributions received or receivable from employer(s)2011-12-31$0
Value of certain deemed distributions of participant loans2011-12-31$2,069
Value of corrective distributions2011-12-31$709
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 : CAM ENVIRONMENTAL 401(K) PLAN 2010 401k financial data
Total income from all sources2010-12-31$113,066
Expenses. Total of all expenses incurred2010-12-31$74,103
Benefits paid (including direct rollovers)2010-12-31$65,434
Total plan assets at end of year2010-12-31$488,283
Total plan assets at beginning of year2010-12-31$449,320
Value of fidelity bond covering the plan2010-12-31$250,000
Total contributions received or receivable from participants2010-12-31$67,973
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$45,093
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$38,963
Net plan assets at end of year (total assets less liabilities)2010-12-31$488,283
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$449,320
Assets. Value of participant loans2010-12-31$19,164
Total contributions received or receivable from employer(s)2010-12-31$0
Value of certain deemed distributions of participant loans2010-12-31$6,908
Value of corrective distributions2010-12-31$1,761
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : CAM ENVIRONMENTAL 401(K) 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 CAM ENVIRONMENTAL 401(K) PLAN

2017: CAM ENVIRONMENTAL 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01This submission is the final filingYes
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: CAM ENVIRONMENTAL 401(K) 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: CAM ENVIRONMENTAL 401(K) 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: CAM ENVIRONMENTAL 401(K) 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: CAM ENVIRONMENTAL 401(K) 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: CAM ENVIRONMENTAL 401(K) 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: CAM ENVIRONMENTAL 401(K) 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: CAM ENVIRONMENTAL 401(K) 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: CAM ENVIRONMENTAL 401(K) 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-54-EA21
Policy instance 1
Insurance contract or identification numberGAP-54-EA21
Number of Individuals Covered0
Total amount of fees paid to insurance companyUSD $2,175
Amount paid for insurance broker fees1740
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-54-EA21
Policy instance 1
Insurance contract or identification numberGAP-54-EA21
Number of Individuals Covered45
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,021
Total amount of fees paid to insurance companyUSD $510
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?Yes
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 $3,021
Amount paid for insurance broker fees510
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-54-EA21
Policy instance 1
Insurance contract or identification numberGAP-54-EA21
Number of Individuals Covered50
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,540
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
Commission paid to Insurance BrokerUSD $2,540
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-54-EA21
Policy instance 1
Insurance contract or identification numberGAP-54-EA21
Number of Individuals Covered39
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,227
Total amount of fees paid to insurance companyUSD $91
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 $2,227
Amount paid for insurance broker fees91
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-54-EA21
Policy instance 1
Insurance contract or identification numberGAP-54-EA21
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,147
Total amount of fees paid to insurance companyUSD $63
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?Yes
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-54-EA21
Policy instance 1
Insurance contract or identification numberGAP-54-EA21
Number of Individuals Covered43
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,876
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?Yes
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 $1,539
Additional information about fees paid to insurance brokerADMINISTRATION
Insurance broker organization code?3
Insurance broker nameIMS SECURITIES, INC.

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