401k Plan data: CCI NETWORK SERVICES 401(K) PLAN plan

CCI NETWORK SERVICES 401(K) PLAN 401k Plan overview

Plan Name	CCI NETWORK SERVICES 401(K) PLAN
Plan identification number	001

CCI NETWORK SERVICES 401(K) PLAN Benefits

401k Plan Type

Defined 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

CCI NETWORK SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name: CCI NETWORK SERVICES, LLC

Employer identification number (EIN): 870709990

NAIC Classification: 517000

Additional information about CCI NETWORK SERVICES, LLC

Jurisdiction of Incorporation: Oregon Secretary of State Corporations Division

Incorporation Date: 2006-05-18

Company Identification Number: 35292697

Legal Registered Office Address: 8130 SW BEAVERTON-HILLSDALE HWY

PORTLAND
United States of America (USA)
97225

More information about CCI NETWORK SERVICES, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CCI NETWORK SERVICES 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 BRIAN PHILLIPS 2023-06-27
001 2021-01-01 BRIAN PHILLIPS 2022-06-15
001 2020-01-01 BRIAN PHILLIPS 2021-07-07
001 2019-01-01
001 2018-01-01 TREVOR MARBLE
001 2017-01-01 TREVOR MARBLE
001 2016-01-01 TREVOR MARBLE
001 2015-01-01 TREVOR MARBLE TREVOR MARBLE 2016-05-20
001 2014-01-01 TREVOR MARBLE TREVOR MARBLE 2015-05-27
001 2013-01-01 TREVOR MARBLE TREVOR MARBLE 2014-05-29

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	BRIAN PHILLIPS	2023-06-27
001	2021-01-01	BRIAN PHILLIPS	2022-06-15
001	2020-01-01	BRIAN PHILLIPS	2021-07-07
001	2019-01-01
001	2018-01-01	TREVOR MARBLE
001	2017-01-01	TREVOR MARBLE
001	2016-01-01	TREVOR MARBLE
001	2015-01-01	TREVOR MARBLE		TREVOR MARBLE	2016-05-20
001	2014-01-01	TREVOR MARBLE		TREVOR MARBLE	2015-05-27
001	2013-01-01	TREVOR MARBLE		TREVOR MARBLE	2014-05-29

Plan Statistics for CCI NETWORK SERVICES 401(K) PLAN

401k plan membership statisitcs for CCI NETWORK SERVICES 401(K) PLAN

Measure Date Value
2019: CCI NETWORK SERVICES 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 22
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 22
Number of participants with account balances 2019-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 0
2018: CCI NETWORK SERVICES 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 22
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 22
Number of participants with account balances 2018-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 0
2017: CCI NETWORK SERVICES 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 22
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 22
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-01-01 0
Total participants 2017-01-01 22
Number of participants with account balances 2017-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: CCI NETWORK SERVICES 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 21
Number of retired or separated participants receiving benefits 2016-01-01 22
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-01-01 0
Total participants 2016-01-01 43
Number of participants with account balances 2016-01-01 20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: CCI NETWORK SERVICES 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 21
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-01-01 0
Total participants 2015-01-01 21
Number of participants with account balances 2015-01-01 19
2014: CCI NETWORK SERVICES 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 20
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 20
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 20
Number of participants with account balances 2014-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: CCI NETWORK SERVICES 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 20
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 20
Number of participants with account balances 2013-01-01 17

Measure	Date	Value
2019: CCI NETWORK SERVICES 401(K) PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	22
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	22
Number of participants with account balances	2019-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	0
2018: CCI NETWORK SERVICES 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	22
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	22
Number of participants with account balances	2018-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	0
2017: CCI NETWORK SERVICES 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	22
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	22
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	22
Number of participants with account balances	2017-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: CCI NETWORK SERVICES 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	21
Number of retired or separated participants receiving benefits	2016-01-01	22
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	43
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	43
Number of participants with account balances	2016-01-01	20
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: CCI NETWORK SERVICES 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	21
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	21
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	21
Number of participants with account balances	2015-01-01	19
2014: CCI NETWORK SERVICES 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	20
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	20
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	20
Number of participants with account balances	2014-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: CCI NETWORK SERVICES 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	20
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	20
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	20
Number of participants with account balances	2013-01-01	17

Financial Data on CCI NETWORK SERVICES 401(K) PLAN

Measure	Date	Value
2019 : CCI NETWORK SERVICES 401(K) PLAN 2019 401k financial data
Total income from all sources	2019-12-31	$832,161
Expenses. Total of all expenses incurred	2019-12-31	$1,974
Total plan assets at end of year	2019-12-31	$2,894,928
Total plan assets at beginning of year	2019-12-31	$2,064,741
Value of fidelity bond covering the plan	2019-12-31	$210,000
Total contributions received or receivable from participants	2019-12-31	$232,716
Expenses. Other expenses not covered elsewhere	2019-12-31	$1,974
Contributions received from other sources (not participants or employers)	2019-12-31	$1,954
Other income received	2019-12-31	$497,137
Net income (gross income less expenses)	2019-12-31	$830,187
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$2,894,928
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$2,064,741
Assets. Value of participant loans	2019-12-31	$70,409
Total contributions received or receivable from employer(s)	2019-12-31	$100,354
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-12-31	$0
2018 : CCI NETWORK SERVICES 401(K) PLAN 2018 401k financial data
Total plan liabilities at end of year	2018-12-31	$857
Total income from all sources	2018-12-31	$118,452
Expenses. Total of all expenses incurred	2018-12-31	$1,499
Total plan assets at end of year	2018-12-31	$2,065,598
Total plan assets at beginning of year	2018-12-31	$1,947,788
Value of fidelity bond covering the plan	2018-12-31	$210,000
Total contributions received or receivable from participants	2018-12-31	$180,953
Expenses. Other expenses not covered elsewhere	2018-12-31	$642
Other income received	2018-12-31	$-160,898
Net income (gross income less expenses)	2018-12-31	$116,953
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$2,064,741
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$1,947,788
Assets. Value of participant loans	2018-12-31	$54,113
Total contributions received or receivable from employer(s)	2018-12-31	$98,397
Value of corrective distributions	2018-12-31	$857
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
2017 : CCI NETWORK SERVICES 401(K) PLAN 2017 401k financial data
Total income from all sources	2017-12-31	$539,394
Expenses. Total of all expenses incurred	2017-12-31	$18,678
Benefits paid (including direct rollovers)	2017-12-31	$18,095
Total plan assets at end of year	2017-12-31	$1,947,788
Total plan assets at beginning of year	2017-12-31	$1,427,072
Value of fidelity bond covering the plan	2017-12-31	$200,000
Total contributions received or receivable from participants	2017-12-31	$170,367
Other income received	2017-12-31	$283,399
Net income (gross income less expenses)	2017-12-31	$520,716
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$1,947,788
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$1,427,072
Assets. Value of participant loans	2017-12-31	$37,987
Total contributions received or receivable from employer(s)	2017-12-31	$85,628
Expenses. Administrative service providers (salaries,fees and commissions)	2017-12-31	$583
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
2016 : CCI NETWORK SERVICES 401(K) PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$296,993
Expenses. Total of all expenses incurred	2016-12-31	$352
Total plan assets at end of year	2016-12-31	$1,427,072
Total plan assets at beginning of year	2016-12-31	$1,130,431
Value of fidelity bond covering the plan	2016-12-31	$150,000
Total contributions received or receivable from participants	2016-12-31	$146,510
Contributions received from other sources (not participants or employers)	2016-12-31	$14,950
Other income received	2016-12-31	$54,325
Net income (gross income less expenses)	2016-12-31	$296,641
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,427,072
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,130,431
Assets. Value of participant loans	2016-12-31	$30,988
Total contributions received or receivable from employer(s)	2016-12-31	$81,208
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$352
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : CCI NETWORK SERVICES 401(K) PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$168,397
Expenses. Total of all expenses incurred	2015-12-31	$0
Total plan assets at end of year	2015-12-31	$1,130,431
Total plan assets at beginning of year	2015-12-31	$962,034
Value of fidelity bond covering the plan	2015-12-31	$120,000
Total contributions received or receivable from participants	2015-12-31	$138,062
Other income received	2015-12-31	$-42,723
Net income (gross income less expenses)	2015-12-31	$168,397
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,130,431
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$962,034
Assets. Value of participant loans	2015-12-31	$3,791
Total contributions received or receivable from employer(s)	2015-12-31	$73,058
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : CCI NETWORK SERVICES 401(K) PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$265,474
Expenses. Total of all expenses incurred	2014-12-31	$0
Total plan assets at end of year	2014-12-31	$962,034
Total plan assets at beginning of year	2014-12-31	$696,560
Value of fidelity bond covering the plan	2014-12-31	$100,000
Total contributions received or receivable from participants	2014-12-31	$125,083
Other income received	2014-12-31	$73,750
Net income (gross income less expenses)	2014-12-31	$265,474
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$962,034
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$696,560
Assets. Value of participant loans	2014-12-31	$6,006
Total contributions received or receivable from employer(s)	2014-12-31	$66,641
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : CCI NETWORK SERVICES 401(K) PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$697,045
Expenses. Total of all expenses incurred	2013-12-31	$485
Total plan assets at end of year	2013-12-31	$696,560
Total plan assets at beginning of year	2013-12-31	$0
Total contributions received or receivable from participants	2013-12-31	$109,870
Contributions received from other sources (not participants or employers)	2013-12-31	$445,805
Other income received	2013-12-31	$76,613
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$696,560
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$696,560
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$0
Assets. Value of participant loans	2013-12-31	$1,250
Total contributions received or receivable from employer(s)	2013-12-31	$64,757
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$485
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0

Form 5500 Responses for CCI NETWORK SERVICES 401(K) PLAN

2019: CCI NETWORK SERVICES 401(K) PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: CCI NETWORK SERVICES 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: CCI NETWORK SERVICES 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: CCI NETWORK SERVICES 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: CCI NETWORK SERVICES 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: CCI NETWORK SERVICES 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: CCI NETWORK SERVICES 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	First time form 5500 has been submitted	Yes
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

786-80041

Policy instance

Insurance contract or identification number	786-80041
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $39
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 fees	39
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )

Policy contract number

786-80078

Policy instance

Insurance contract or identification number	786-80078
Number of Individuals Covered	1
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $41
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 fees	41
Additional information about fees paid to insurance broker	FEEA
Insurance broker organization code?	3

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Company Name:	CCI NETWORK SERVICES, LLC
Employer identification number (EIN):	870709990
NAIC Classification:	517000

Jurisdiction of Incorporation:	Oregon Secretary of State Corporations Division
Incorporation Date:	2006-05-18
Company Identification Number:	35292697
Legal Registered Office Address:	8130 SW BEAVERTON-HILLSDALE HWY PORTLAND United States of America (USA) 97225