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PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS 401k Plan overview

Plan NamePRISMA HEALTH-UPSTATE RETIREMENT SAVINGS
Plan identification number 005

PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS 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.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Life insurance

401k Sponsoring company profile

PRISMA HEALTH has sponsored the creation of one or more 401k plans.

Company Name:PRISMA HEALTH
Employer identification number (EIN):811723202
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0052022-01-01
0052021-01-01
0052020-01-01

Plan Statistics for PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS

401k plan membership statisitcs for PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS

Measure Date Value
2022: PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS 2022 401k membership
Total participants, beginning-of-year2022-01-0133,628
Total number of active participants reported on line 7a of the Form 55002022-01-0128,745
Number of retired or separated participants receiving benefits2022-01-0185
Number of other retired or separated participants entitled to future benefits2022-01-016,480
Total of all active and inactive participants2022-01-0135,310
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-011
Total participants2022-01-0135,311
Number of participants with account balances2022-01-0135,311
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS 2021 401k membership
Total participants, beginning-of-year2021-01-0136,881
Total number of active participants reported on line 7a of the Form 55002021-01-0127,548
Number of retired or separated participants receiving benefits2021-01-0173
Number of other retired or separated participants entitled to future benefits2021-01-016,006
Total of all active and inactive participants2021-01-0133,627
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-011
Total participants2021-01-0133,628
Number of participants with account balances2021-01-0133,628
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS 2020 401k membership
Total participants, beginning-of-year2020-01-0118,238
Total number of active participants reported on line 7a of the Form 55002020-01-0129,954
Number of retired or separated participants receiving benefits2020-01-0163
Number of other retired or separated participants entitled to future benefits2020-01-016,864
Total of all active and inactive participants2020-01-0136,881
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-0136,881
Number of participants with account balances2020-01-0134,630
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-011

Financial Data on PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS

Measure Date Value
2022 : PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS 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$0
Total income from all sources (including contributions)2022-12-31$-68,940,797
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$136,381,822
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$135,793,701
Expenses. Certain deemed distributions of participant loans2022-12-31$102,026
Value of total corrective distributions2022-12-31$15,876
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$179,656,328
Value of total assets at end of year2022-12-31$1,580,787,343
Value of total assets at beginning of year2022-12-31$1,786,109,962
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$470,219
Total interest from all sources2022-12-31$5,580,295
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$18,211,385
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$18,211,385
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$20,000,000
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$166,831,502
Participant contributions at end of year2022-12-31$21,978,403
Participant contributions at beginning of year2022-12-31$20,721,760
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$12,824,826
Administrative expenses (other) incurred2022-12-31$26,500
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-205,322,619
Value of net assets at end of year (total assets less liabilities)2022-12-31$1,580,787,343
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$1,786,109,962
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$1,297,960,685
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$1,500,568,999
Interest on participant loans2022-12-31$973,800
Interest earned on other investments2022-12-31$4,606,495
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-12-31$260,848,255
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-12-31$264,819,203
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-272,388,805
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$135,793,701
Contract administrator fees2022-12-31$443,719
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 name2022-12-31ELLIOTTT DAVIS, LLLC
Accountancy firm EIN2022-12-31570381582
2021 : PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS 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$0
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$380,060,254
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$142,511,930
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$141,880,571
Expenses. Certain deemed distributions of participant loans2021-12-31$155,374
Value of total corrective distributions2021-12-31$24,217
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$166,852,497
Value of total assets at end of year2021-12-31$1,786,109,962
Value of total assets at beginning of year2021-12-31$1,548,561,638
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$451,768
Total interest from all sources2021-12-31$5,690,183
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$19,643,353
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$19,643,353
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$20,000,000
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$152,321,808
Participant contributions at end of year2021-12-31$20,721,760
Participant contributions at beginning of year2021-12-31$20,552,381
Income. Received or receivable in cash from other sources (including rollovers)2021-12-31$14,530,689
Administrative expenses (other) incurred2021-12-31$451,768
Total non interest bearing cash at end of year2021-12-31$0
Total non interest bearing cash at beginning of year2021-12-31$64
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$237,548,324
Value of net assets at end of year (total assets less liabilities)2021-12-31$1,786,109,962
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$1,548,561,638
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$1,500,568,999
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$1,269,416,583
Interest on participant loans2021-12-31$1,030,328
Interest earned on other investments2021-12-31$4,659,855
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-12-31$264,819,203
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-12-31$258,592,610
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$187,874,221
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$141,880,571
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 plan2021-12-31Unqualified
Accountancy firm name2021-12-31ELLIOTTT DAVIS, LLLC
Accountancy firm EIN2021-12-31570381582
2020 : PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total transfer of assets to this plan2020-12-31$4,485,849
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$323,109,960
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$125,856,276
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$125,019,035
Expenses. Certain deemed distributions of participant loans2020-12-31$349,478
Value of total corrective distributions2020-12-31$46,428
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$148,349,528
Value of total assets at end of year2020-12-31$1,548,561,638
Value of total assets at beginning of year2020-12-31$1,346,822,105
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$441,335
Total interest from all sources2020-12-31$7,410,250
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$15,013,314
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$15,013,314
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$20,000,000
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$132,898,401
Participant contributions at end of year2020-12-31$20,552,381
Participant contributions at beginning of year2020-12-31$14,510,715
Participant contributions at beginning of year2020-12-31$2,223,814
Income. Received or receivable in cash from other sources (including rollovers)2020-12-31$15,451,127
Administrative expenses (other) incurred2020-12-31$441,335
Total non interest bearing cash at end of year2020-12-31$64
Total non interest bearing cash at beginning of year2020-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$197,253,684
Value of net assets at end of year (total assets less liabilities)2020-12-31$1,548,561,638
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$1,346,822,105
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$1,269,416,583
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$1,046,269,222
Interest on participant loans2020-12-31$1,227,266
Interest earned on other investments2020-12-31$6,182,984
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-12-31$258,592,610
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-12-31$283,818,354
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$152,336,868
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$125,019,035
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 name2020-12-31ELLIOTTT DAVIS, LLLC
Accountancy firm EIN2020-12-31570381582

Form 5500 Responses for PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS

2022: PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS 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: PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS 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: PRISMA HEALTH-UPSTATE RETIREMENT SAVINGS 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

Insurance Providers Used on plan

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number57947
Policy instance 1
Insurance contract or identification number57947
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 Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number915504
Policy instance 2
Insurance contract or identification number915504
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
Additional information about fees paid to insurance brokerTO PROVIDE ASSET ALLOCATION ADVICE AND REBALANCING SERVICES FOR PLAN PARTICIPANT WHO ELECTED TO RECEIVE
Insurance broker organization code?3
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number041129
Policy instance 3
Insurance contract or identification number041129
Number of Individuals Covered35311
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number57947
Policy instance 1
Insurance contract or identification number57947
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 Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number915504
Policy instance 2
Insurance contract or identification number915504
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
Additional information about fees paid to insurance brokerTO PROVIDE ASSET ALLOCATION ADVICE AND REBALANCING SERVICES FOR PLAN PARTICIPANT WHO ELECTED TO RECEIVE
Insurance broker organization code?3
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number041129
Policy instance 3
Insurance contract or identification number041129
Number of Individuals Covered33628
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?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number57947
Policy instance 1
Insurance contract or identification number57947
Number of Individuals Covered122
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 Administration1
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number915504
Policy instance 2
Insurance contract or identification number915504
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,394
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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
Amount paid for insurance broker fees3394
Additional information about fees paid to insurance brokerTO PROVIDE ASSET ALLOCATION ADVICE AND REBALANCING SERVICES FOR PLAN PARTICIPANT WHO ELECTED TO RECEIVE
Insurance broker organization code?3
PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 )
Policy contract number041129
Policy instance 3
Insurance contract or identification number041129
Number of Individuals Covered36881
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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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