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NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 401k Plan overview

Plan NameNORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN
Plan identification number 001

NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. has sponsored the creation of one or more 401k plans.

Company Name:NORTHERN COLORADO SURGICAL ASSOCIATES, P.C.
Employer identification number (EIN):840602687
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Additional information about NORTHERN COLORADO SURGICAL ASSOCIATES, P.C.

Jurisdiction of Incorporation: Colorado Department of State
Incorporation Date: 1970-09-03
Company Identification Number: 19871222393
Legal Registered Office Address: 2121 E HARMONY ROAD STE 250

Fort Collins
United States of America (USA)
80528

More information about NORTHERN COLORADO SURGICAL ASSOCIATES, P.C.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012019-07-01DARCY THOR2020-09-18
0012018-07-01DARCY THOR2020-04-14
0012017-07-01
0012016-07-01
0012015-07-01GARY A. JOHNSON
0012014-07-01GARY A. JOHNSON
0012014-07-01GARY A. JOHNSON
0012013-07-01GARY A. JOHNSON
0012012-07-01GARY A. JOHNSON
0012011-07-01GARY A. JOHNSON
0012010-07-01GARY A. JOHNSON
0012009-07-01GARY A. JOHNSON

Plan Statistics for NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN

401k plan membership statisitcs for NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN

Measure Date Value
2016: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-0120
Total number of active participants reported on line 7a of the Form 55002016-07-0114
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-016
Total of all active and inactive participants2016-07-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-07-010
Total participants2016-07-0120
Number of participants with account balances2016-07-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-07-010
2015: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-0120
Total number of active participants reported on line 7a of the Form 55002015-07-0115
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-015
Total of all active and inactive participants2015-07-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-07-010
Total participants2015-07-0120
Number of participants with account balances2015-07-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-07-010
2014: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-0120
Total number of active participants reported on line 7a of the Form 55002014-07-0115
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-015
Total of all active and inactive participants2014-07-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-07-010
Total participants2014-07-0120
Number of participants with account balances2014-07-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-07-010
2013: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-0121
Total number of active participants reported on line 7a of the Form 55002013-07-0116
Number of retired or separated participants receiving benefits2013-07-012
Number of other retired or separated participants entitled to future benefits2013-07-012
Total of all active and inactive participants2013-07-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-07-010
Total participants2013-07-0120
Number of participants with account balances2013-07-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-07-010
2012: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-0120
Total number of active participants reported on line 7a of the Form 55002012-07-0117
Number of retired or separated participants receiving benefits2012-07-013
Number of other retired or separated participants entitled to future benefits2012-07-011
Total of all active and inactive participants2012-07-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-010
Total participants2012-07-0121
Number of participants with account balances2012-07-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-07-010
2011: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-0121
Total number of active participants reported on line 7a of the Form 55002011-07-0116
Number of retired or separated participants receiving benefits2011-07-013
Number of other retired or separated participants entitled to future benefits2011-07-011
Total of all active and inactive participants2011-07-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-07-010
Total participants2011-07-0120
Number of participants with account balances2011-07-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-07-010
2010: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-07-0121
Total number of active participants reported on line 7a of the Form 55002010-07-0117
Number of retired or separated participants receiving benefits2010-07-013
Number of other retired or separated participants entitled to future benefits2010-07-011
Total of all active and inactive participants2010-07-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-07-010
Total participants2010-07-0121
Number of participants with account balances2010-07-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-07-010
2009: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-0121
Total number of active participants reported on line 7a of the Form 55002009-07-0117
Number of retired or separated participants receiving benefits2009-07-010
Number of other retired or separated participants entitled to future benefits2009-07-014
Total of all active and inactive participants2009-07-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-07-010
Total participants2009-07-0121
Number of participants with account balances2009-07-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-07-010

Financial Data on NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN

Measure Date Value
2017 : NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2017 401k financial data
Total plan liabilities at end of year2017-06-30$0
Total plan liabilities at beginning of year2017-06-30$0
Total income from all sources2017-06-30$2,249,598
Expenses. Total of all expenses incurred2017-06-30$474,649
Benefits paid (including direct rollovers)2017-06-30$474,649
Total plan assets at end of year2017-06-30$10,533,278
Total plan assets at beginning of year2017-06-30$8,758,329
Value of fidelity bond covering the plan2017-06-30$500,000
Total contributions received or receivable from participants2017-06-30$120,583
Expenses. Other expenses not covered elsewhere2017-06-30$0
Contributions received from other sources (not participants or employers)2017-06-30$0
Other income received2017-06-30$1,908,237
Noncash contributions received2017-06-30$0
Net income (gross income less expenses)2017-06-30$1,774,949
Net plan assets at end of year (total assets less liabilities)2017-06-30$10,533,278
Net plan assets at beginning of year (total assets less liabilities)2017-06-30$8,758,329
Assets. Value of assets in partnership/joint-venture interests2017-06-30$10,947
Total contributions received or receivable from employer(s)2017-06-30$220,778
Value of certain deemed distributions of participant loans2017-06-30$0
Value of corrective distributions2017-06-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-06-30$0
2016 : NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-06-30$383,336
Expenses. Total of all expenses incurred2016-06-30$15,390
Total plan assets at end of year2016-06-30$8,758,329
Total plan assets at beginning of year2016-06-30$8,390,383
Value of fidelity bond covering the plan2016-06-30$500,000
Total contributions received or receivable from participants2016-06-30$164,515
Other income received2016-06-30$-24,379
Net income (gross income less expenses)2016-06-30$367,946
Net plan assets at end of year (total assets less liabilities)2016-06-30$8,758,329
Net plan assets at beginning of year (total assets less liabilities)2016-06-30$8,390,383
Assets. Value of assets in partnership/joint-venture interests2016-06-30$10,947
Total contributions received or receivable from employer(s)2016-06-30$243,200
Expenses. Administrative service providers (salaries,fees and commissions)2016-06-30$15,390
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-06-30$0
2015 : NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-06-30$645,644
Expenses. Total of all expenses incurred2015-06-30$1,061,141
Benefits paid (including direct rollovers)2015-06-30$1,050,266
Total plan assets at end of year2015-06-30$7,434,263
Total plan assets at beginning of year2015-06-30$7,849,760
Value of fidelity bond covering the plan2015-06-30$500,000
Total contributions received or receivable from participants2015-06-30$141,944
Other income received2015-06-30$255,635
Net income (gross income less expenses)2015-06-30$-415,497
Net plan assets at end of year (total assets less liabilities)2015-06-30$7,434,263
Net plan assets at beginning of year (total assets less liabilities)2015-06-30$7,849,760
Assets. Value of assets in partnership/joint-venture interests2015-06-30$19,572
Total contributions received or receivable from employer(s)2015-06-30$248,065
Expenses. Administrative service providers (salaries,fees and commissions)2015-06-30$10,875
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-06-30$0
2014 : NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-06-30$1,692,965
Expenses. Total of all expenses incurred2014-06-30$223,919
Benefits paid (including direct rollovers)2014-06-30$212,167
Total plan assets at end of year2014-06-30$7,849,760
Total plan assets at beginning of year2014-06-30$6,380,714
Value of fidelity bond covering the plan2014-06-30$500,000
Total contributions received or receivable from participants2014-06-30$134,861
Other income received2014-06-30$1,312,413
Net income (gross income less expenses)2014-06-30$1,469,046
Net plan assets at end of year (total assets less liabilities)2014-06-30$7,849,760
Net plan assets at beginning of year (total assets less liabilities)2014-06-30$6,380,714
Assets. Value of assets in partnership/joint-venture interests2014-06-30$15,000
Total contributions received or receivable from employer(s)2014-06-30$245,691
Expenses. Administrative service providers (salaries,fees and commissions)2014-06-30$11,752
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-06-30$0
2013 : NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-06-30$1,079,288
Expenses. Total of all expenses incurred2013-06-30$23,092
Benefits paid (including direct rollovers)2013-06-30$9,662
Total plan assets at end of year2013-06-30$6,380,714
Total plan assets at beginning of year2013-06-30$5,324,518
Value of fidelity bond covering the plan2013-06-30$500,000
Total contributions received or receivable from participants2013-06-30$135,387
Expenses. Other expenses not covered elsewhere2013-06-30$0
Contributions received from other sources (not participants or employers)2013-06-30$0
Other income received2013-06-30$698,410
Noncash contributions received2013-06-30$0
Net income (gross income less expenses)2013-06-30$1,056,196
Net plan assets at end of year (total assets less liabilities)2013-06-30$6,380,714
Net plan assets at beginning of year (total assets less liabilities)2013-06-30$5,324,518
Assets. Value of assets in partnership/joint-venture interests2013-06-30$5
Total contributions received or receivable from employer(s)2013-06-30$245,491
Value of certain deemed distributions of participant loans2013-06-30$0
Value of corrective distributions2013-06-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-06-30$13,430
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-06-30$0
2012 : NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-06-30$352,720
Expenses. Total of all expenses incurred2012-06-30$56,557
Benefits paid (including direct rollovers)2012-06-30$41,378
Total plan assets at end of year2012-06-30$5,324,518
Total plan assets at beginning of year2012-06-30$5,028,355
Value of fidelity bond covering the plan2012-06-30$500,000
Total contributions received or receivable from participants2012-06-30$121,576
Other income received2012-06-30$-15,204
Net income (gross income less expenses)2012-06-30$296,163
Net plan assets at end of year (total assets less liabilities)2012-06-30$5,324,518
Net plan assets at beginning of year (total assets less liabilities)2012-06-30$5,028,355
Assets. Value of assets in partnership/joint-venture interests2012-06-30$5
Total contributions received or receivable from employer(s)2012-06-30$246,348
Expenses. Administrative service providers (salaries,fees and commissions)2012-06-30$15,179
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-06-30$0
2011 : NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-06-30$1,212,227
Expenses. Total of all expenses incurred2011-06-30$104,049
Benefits paid (including direct rollovers)2011-06-30$90,640
Total plan assets at end of year2011-06-30$5,028,355
Total plan assets at beginning of year2011-06-30$3,920,177
Value of fidelity bond covering the plan2011-06-30$500,000
Total contributions received or receivable from participants2011-06-30$111,281
Expenses. Other expenses not covered elsewhere2011-06-30$13,409
Other income received2011-06-30$852,735
Net income (gross income less expenses)2011-06-30$1,108,178
Net plan assets at end of year (total assets less liabilities)2011-06-30$5,028,355
Net plan assets at beginning of year (total assets less liabilities)2011-06-30$3,920,177
Assets. Value of assets in partnership/joint-venture interests2011-06-30$5
Total contributions received or receivable from employer(s)2011-06-30$248,211
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-06-30$0
2010 : NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2010 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-06-30$0

Form 5500 Responses for NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN

2016: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2015: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2014: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedYes
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2013: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2012: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2011: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement - TrustYes
2010: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan funding arrangement – TrustYes
2010-07-01Plan benefit arrangement – InsuranceYes
2010-07-01Plan benefit arrangement - TrustYes
2009: NORTHERN COLORADO SURGICAL ASSOCIATES, P.C. PROFIT SHARING PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number33944042
Policy instance 1
Insurance contract or identification number33944042
Number of Individuals Covered1
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number38200475
Policy instance 2
Insurance contract or identification number38200475
Number of Individuals Covered1
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07840S
Policy instance 1
Insurance contract or identification number07840S
Number of Individuals Covered1
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number33944042
Policy instance 1
Insurance contract or identification number33944042
Number of Individuals Covered1
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number38200475
Policy instance 2
Insurance contract or identification number38200475
Number of Individuals Covered1
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07840S
Policy instance 1
Insurance contract or identification number07840S
Number of Individuals Covered1
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07840S
Policy instance 1
Insurance contract or identification number07840S
Number of Individuals Covered1
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07840S
Policy instance 1
Insurance contract or identification number07840S
Number of Individuals Covered1
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number07840S
Policy instance 1
Insurance contract or identification number07840S
Number of Individuals Covered1
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Are there contracts with allocated funds for individual policies?Yes
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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