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UGSI 401(K) SAVINGS PLAN 401k Plan overview

Plan NameUGSI 401(K) SAVINGS PLAN
Plan identification number 001

UGSI 401(K) SAVINGS 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

UGSI SOLUTIONS, INC. has sponsored the creation of one or more 401k plans.

Company Name:UGSI SOLUTIONS, INC.
Employer identification number (EIN):810906606
NAIC Classification:221300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UGSI 401(K) SAVINGS PLAN

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
0012019-01-01
0012018-01-01
0012017-01-01CHRISTOPHER CHISHOLM
0012016-01-01CHRISTOPHER CHISHOLM
0012015-01-01CHRISTOPHER CHISHOLM

Plan Statistics for UGSI 401(K) SAVINGS PLAN

401k plan membership statisitcs for UGSI 401(K) SAVINGS PLAN

Measure Date Value
2022: UGSI 401(K) SAVINGS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01209
Total number of active participants reported on line 7a of the Form 55002022-01-01139
Number of retired or separated participants receiving benefits2022-01-016
Number of other retired or separated participants entitled to future benefits2022-01-0143
Total of all active and inactive participants2022-01-01188
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01188
Number of participants with account balances2022-01-01137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: UGSI 401(K) SAVINGS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01201
Total number of active participants reported on line 7a of the Form 55002021-01-01164
Number of retired or separated participants receiving benefits2021-01-011
Number of other retired or separated participants entitled to future benefits2021-01-0138
Total of all active and inactive participants2021-01-01203
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-01203
Number of participants with account balances2021-01-01141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: UGSI 401(K) SAVINGS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01229
Total number of active participants reported on line 7a of the Form 55002020-01-01158
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0139
Total of all active and inactive participants2020-01-01197
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01197
Number of participants with account balances2020-01-01145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: UGSI 401(K) SAVINGS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01228
Total number of active participants reported on line 7a of the Form 55002019-01-01169
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-0156
Total of all active and inactive participants2019-01-01226
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01226
Number of participants with account balances2019-01-01172
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: UGSI 401(K) SAVINGS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01205
Total number of active participants reported on line 7a of the Form 55002018-01-01170
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0157
Total of all active and inactive participants2018-01-01227
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01227
Number of participants with account balances2018-01-01165
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-014
2017: UGSI 401(K) SAVINGS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01176
Total number of active participants reported on line 7a of the Form 55002017-01-01154
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0155
Total of all active and inactive participants2017-01-01209
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01209
Number of participants with account balances2017-01-01160
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: UGSI 401(K) SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01211
Total number of active participants reported on line 7a of the Form 55002016-01-01125
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0147
Total of all active and inactive participants2016-01-01172
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01172
Number of participants with account balances2016-01-01132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: UGSI 401(K) SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01196
Total number of active participants reported on line 7a of the Form 55002015-01-01186
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0124
Total of all active and inactive participants2015-01-01210
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01210
Number of participants with account balances2015-01-01150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010

Financial Data on UGSI 401(K) SAVINGS PLAN

Measure Date Value
2022 : UGSI 401(K) SAVINGS PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$2,573
Total income from all sources (including contributions)2022-12-31$-945,531
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$1,321,218
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,291,745
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$935,881
Value of total assets at end of year2022-12-31$9,174,582
Value of total assets at beginning of year2022-12-31$11,443,904
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$29,473
Total interest from all sources2022-12-31$13,426
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$852,607
Participant contributions at end of year2022-12-31$274,250
Participant contributions at beginning of year2022-12-31$280,879
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$586
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$83,274
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$2,573
Other income not declared elsewhere2022-12-31$-53,575
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-2,266,749
Value of net assets at end of year (total assets less liabilities)2022-12-31$9,174,582
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$11,441,331
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$8,562,398
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$10,820,593
Interest on participant loans2022-12-31$13,426
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$451
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$447
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$447
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$337,483
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$341,399
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-1,841,263
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,291,745
Contract administrator fees2022-12-31$29,473
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31GOFF BACKA ALFERA & COMPANY LLC
Accountancy firm EIN2022-12-31251871184
2021 : UGSI 401(K) SAVINGS PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$2,573
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$2,474,658
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$609,340
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$575,070
Value of total corrective distributions2021-12-31$2,573
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$1,234,713
Value of total assets at end of year2021-12-31$11,443,904
Value of total assets at beginning of year2021-12-31$9,576,013
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$31,697
Total interest from all sources2021-12-31$15,760
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2021-12-31$0
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$799,013
Participant contributions at end of year2021-12-31$280,879
Participant contributions at beginning of year2021-12-31$243,604
Participant contributions at end of year2021-12-31$586
Participant contributions at beginning of year2021-12-31$817
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$435,700
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$2,573
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,865,318
Value of net assets at end of year (total assets less liabilities)2021-12-31$11,441,331
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$9,576,013
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$10,820,593
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$8,778,969
Interest on participant loans2021-12-31$15,760
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$447
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$5,759
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$5,759
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$341,399
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$546,864
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$1,224,185
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$575,070
Contract administrator fees2021-12-31$31,697
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Disclaimer
Accountancy firm name2021-12-31GOFF BACKA ALFERA & COMPANY LLC
Accountancy firm EIN2021-12-31251871184
2020 : UGSI 401(K) SAVINGS PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$1,933,736
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$1,453,173
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$1,427,379
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$773,268
Value of total assets at end of year2020-12-31$9,576,013
Value of total assets at beginning of year2020-12-31$9,095,450
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$25,794
Total interest from all sources2020-12-31$12,160
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2020-12-31$0
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$770,292
Participant contributions at end of year2020-12-31$243,604
Participant contributions at beginning of year2020-12-31$195,357
Participant contributions at end of year2020-12-31$817
Participant contributions at beginning of year2020-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$2,976
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$480,563
Value of net assets at end of year (total assets less liabilities)2020-12-31$9,576,013
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$9,095,450
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$8,778,969
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$8,456,954
Interest on participant loans2020-12-31$12,160
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$5,759
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$578
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$578
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$546,864
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$442,561
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$1,148,308
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$1,427,379
Contract administrator fees2020-12-31$25,794
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31GOFF BACKA ALFERA & COMPANY LLC
Accountancy firm EIN2020-12-31251871184
2019 : UGSI 401(K) SAVINGS PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$2,450,354
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$804,613
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$741,110
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$820,401
Value of total assets at end of year2019-12-31$9,095,450
Value of total assets at beginning of year2019-12-31$7,449,709
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$63,503
Total interest from all sources2019-12-31$12,228
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$816,401
Participant contributions at end of year2019-12-31$195,357
Participant contributions at beginning of year2019-12-31$181,249
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$22,012
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$4,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$1,645,741
Value of net assets at end of year (total assets less liabilities)2019-12-31$9,095,450
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$7,449,709
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$63,503
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$8,456,954
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$6,966,018
Interest on participant loans2019-12-31$12,220
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$578
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$570
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$570
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$8
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$442,561
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$279,860
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$1,617,725
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31Yes
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$741,110
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31GOFF BACKA ALFERA & COMPANY LLC
Accountancy firm EIN2019-12-31251871184
2018 : UGSI 401(K) SAVINGS PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$350,187
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$570,633
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$504,535
Expenses. Certain deemed distributions of participant loans2018-12-31$3,178
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$827,530
Value of total assets at end of year2018-12-31$7,449,709
Value of total assets at beginning of year2018-12-31$7,670,155
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$62,920
Total interest from all sources2018-12-31$9,831
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$770,871
Participant contributions at end of year2018-12-31$181,249
Participant contributions at beginning of year2018-12-31$173,052
Participant contributions at end of year2018-12-31$22,012
Participant contributions at beginning of year2018-12-31$23,770
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$56,659
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Income. Non cash contributions2018-12-31$0
Value of net income/loss2018-12-31$-220,446
Value of net assets at end of year (total assets less liabilities)2018-12-31$7,449,709
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$7,670,155
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$62,920
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$6,966,018
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$7,224,162
Interest on participant loans2018-12-31$9,831
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$570
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$540
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$540
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$279,860
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$248,631
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-487,174
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$504,535
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31GOFF BACKA ALFERA & COMPANY LLC
Accountancy firm EIN2018-12-31251871184
2017 : UGSI 401(K) SAVINGS PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total transfer of assets to this plan2017-12-31$1,239,881
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$1,758,664
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$1,003,538
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$949,834
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$725,401
Value of total assets at end of year2017-12-31$7,670,155
Value of total assets at beginning of year2017-12-31$5,675,148
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$53,704
Total interest from all sources2017-12-31$9,447
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$662,423
Participant contributions at end of year2017-12-31$173,052
Participant contributions at beginning of year2017-12-31$163,593
Participant contributions at end of year2017-12-31$23,770
Participant contributions at beginning of year2017-12-31$594
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$62,978
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$0
Other income not declared elsewhere2017-12-31$36
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$755,126
Value of net assets at end of year (total assets less liabilities)2017-12-31$7,670,155
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$5,675,148
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$16,534
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$7,224,162
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$5,283,139
Interest on participant loans2017-12-31$9,447
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$540
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$540
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$540
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$248,631
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$227,282
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$1,023,780
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$949,834
Contract administrator fees2017-12-31$37,170
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31GOFF BACKA ALFERA & COMPANY LLC
Accountancy firm EIN2017-12-31251871184
2016 : UGSI 401(K) SAVINGS PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$1,139,012
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$2,757,867
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$2,708,338
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$662,375
Value of total assets at end of year2016-12-31$5,675,148
Value of total assets at beginning of year2016-12-31$7,294,003
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$49,529
Total interest from all sources2016-12-31$12,671
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$630,589
Participant contributions at end of year2016-12-31$163,593
Participant contributions at beginning of year2016-12-31$277,291
Participant contributions at end of year2016-12-31$594
Participant contributions at beginning of year2016-12-31$11,141
Income. Received or receivable in cash from other sources (including rollovers)2016-12-31$31,786
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$0
Administrative expenses (other) incurred2016-12-31$6,533
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-1,618,855
Value of net assets at end of year (total assets less liabilities)2016-12-31$5,675,148
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$7,294,003
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$14,569
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$5,283,139
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$6,691,696
Interest on participant loans2016-12-31$12,671
Value of interest in common/collective trusts at end of year2016-12-31$0
Value of interest in common/collective trusts at beginning of year2016-12-31$313,332
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$540
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$543
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$543
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$227,282
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$463,966
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31Yes
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$2,708,338
Contract administrator fees2016-12-31$28,427
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31GOFF BACKA ALFERA & COMPANY LLC
Accountancy firm EIN2016-12-31251871184
2015 : UGSI 401(K) SAVINGS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$423
Total income from all sources (including contributions)2015-12-31$1,407,728
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$303,154
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$303,154
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,541,302
Value of total assets at end of year2015-12-31$7,294,003
Value of total assets at beginning of year2015-12-31$6,189,852
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$0
Total interest from all sources2015-12-31$10,756
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$963,980
Participant contributions at end of year2015-12-31$277,291
Participant contributions at beginning of year2015-12-31$162,707
Participant contributions at end of year2015-12-31$11,141
Participant contributions at beginning of year2015-12-31$35,155
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$577,322
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$423
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$1,104,574
Value of net assets at end of year (total assets less liabilities)2015-12-31$7,294,003
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$6,189,429
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$6,691,696
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$5,869,467
Value of interest in pooled separate accounts at end of year2015-12-31$0
Value of interest in pooled separate accounts at beginning of year2015-12-31$0
Interest on participant loans2015-12-31$10,756
Value of interest in common/collective trusts at end of year2015-12-31$313,332
Value of interest in common/collective trusts at beginning of year2015-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$543
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$122,523
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$122,523
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-144,330
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$303,154
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31GOFF BACKA ALFERA & COMPANY LLC
Accountancy firm EIN2015-12-31251871184

Form 5500 Responses for UGSI 401(K) SAVINGS PLAN

2022: UGSI 401(K) SAVINGS PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
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: UGSI 401(K) SAVINGS PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final 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: UGSI 401(K) SAVINGS PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: UGSI 401(K) SAVINGS PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: UGSI 401(K) SAVINGS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: UGSI 401(K) SAVINGS PLAN 2017 form 5500 responses
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: UGSI 401(K) SAVINGS PLAN 2016 form 5500 responses
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: UGSI 401(K) SAVINGS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-HB3Q
Policy instance 1
Insurance contract or identification numberGAP-CP-HB3Q
Number of Individuals Covered6
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-HB3Q
Policy instance 1
Insurance contract or identification numberGAP-CP-HB3Q
Number of Individuals Covered7
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-HB3Q
Policy instance 1
Insurance contract or identification numberGAP-CP-HB3Q
Number of Individuals Covered7
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-HB3Q
Policy instance 1
Insurance contract or identification numberGAP-CP-HB3Q
Number of Individuals Covered9
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-HB3Q
Policy instance 1
Insurance contract or identification numberGAP-CP-HB3Q
Number of Individuals Covered9
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract numberGAP-CP-HB3Q
Policy instance 1
Insurance contract or identification numberGAP-CP-HB3Q
Number of Individuals Covered9
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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