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NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NameNIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN
Plan identification number 003

NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

NIBBELINK MASONRY CONSTRUCTION CORP. has sponsored the creation of one or more 401k plans.

Company Name:NIBBELINK MASONRY CONSTRUCTION CORP.
Employer identification number (EIN):953273187
NAIC Classification:238100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032022-01-01TROY NIBBELINK2023-09-26
0032021-01-01TROY NIBBELINK2022-10-11
0032020-01-01TROY NIBBELINK2021-10-12
0032020-01-01TROY NIBBELINK2021-10-12
0032019-01-01TROY NIBBELINK2020-09-30 TROY NIBBELINK2020-09-30
0032018-01-01
0032017-01-01
0032016-01-01
0032015-01-01
0032014-01-01
0032013-01-01
0032012-01-01MARY PAULSON2013-10-09
0032011-01-01MARY PAULSON2012-10-04
0032010-01-01MARY PAULSON2011-10-17

Plan Statistics for NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN

Measure Date Value
2022: NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0198
Total number of active participants reported on line 7a of the Form 55002022-01-0178
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0120
Total of all active and inactive participants2022-01-0198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-0198
Number of participants with account balances2022-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01107
Total number of active participants reported on line 7a of the Form 55002021-01-0182
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-0116
Total of all active and inactive participants2021-01-0198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0198
Number of participants with account balances2021-01-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2020: NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01114
Total number of active participants reported on line 7a of the Form 55002020-01-0192
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-0115
Total of all active and inactive participants2020-01-01107
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01107
Number of participants with account balances2020-01-0139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
2019: NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01137
Total number of active participants reported on line 7a of the Form 55002019-01-0195
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0119
Total of all active and inactive participants2019-01-01114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01114
Number of participants with account balances2019-01-0149
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010

Financial Data on NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN

Measure Date Value
2022 : NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-419,067
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$27,567
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,398
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$93,628
Value of total assets at end of year2022-12-31$2,831,632
Value of total assets at beginning of year2022-12-31$3,278,266
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$26,169
Total interest from all sources2022-12-31$87,837
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$-600,532
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$-600,532
Administrative expenses professional fees incurred2022-12-31$26,169
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$400,000
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$93,628
Participant contributions at end of year2022-12-31$58,120
Participant contributions at beginning of year2022-12-31$37,689
Participant contributions at end of year2022-12-31$807
Participant contributions at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-446,634
Value of net assets at end of year (total assets less liabilities)2022-12-31$2,831,632
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$3,278,266
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$2,772,705
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$3,240,577
Interest on participant loans2022-12-31$3,213
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$84,624
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,398
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 name2022-12-31LEE CPA AUDIT GROUP
Accountancy firm EIN2022-12-31814637885
2021 : NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$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$474,425
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$47,373
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$0
Value of total corrective distributions2021-12-31$16,500
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$98,996
Value of total assets at end of year2021-12-31$3,278,266
Value of total assets at beginning of year2021-12-31$2,851,214
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$30,873
Total interest from all sources2021-12-31$257,834
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$116,693
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$116,693
Administrative expenses professional fees incurred2021-12-31$30,873
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$400,000
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$98,996
Participant contributions at end of year2021-12-31$37,689
Participant contributions at beginning of year2021-12-31$65,877
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$2,500
Other income not declared elsewhere2021-12-31$902
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$427,052
Value of net assets at end of year (total assets less liabilities)2021-12-31$3,278,266
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$2,851,214
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$3,240,577
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$2,782,837
Interest on participant loans2021-12-31$3,123
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$254,711
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
Liabilities. Value of benefit claims payable at end of year2021-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$0
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 name2021-12-31LEE CPA AUDIT GROUP
Accountancy firm EIN2021-12-31814637885
2020 : NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$2,140
Total income from all sources (including contributions)2020-12-31$425,006
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$174,070
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$147,862
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$95,237
Value of total assets at end of year2020-12-31$2,851,214
Value of total assets at beginning of year2020-12-31$2,602,418
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$26,208
Total interest from all sources2020-12-31$78,892
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$250,877
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$250,877
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$400,000
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$95,237
Participant contributions at end of year2020-12-31$65,877
Participant contributions at beginning of year2020-12-31$71,877
Participant contributions at end of year2020-12-31$2,500
Participant contributions at beginning of year2020-12-31$1,270
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$250,936
Value of net assets at end of year (total assets less liabilities)2020-12-31$2,851,214
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$2,600,278
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$2,782,837
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$2,529,271
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$78,892
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$147,862
Contract administrator fees2020-12-31$26,208
Liabilities. Value of benefit claims payable at end of year2020-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$2,140
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 plan2020-12-31Unqualified
Accountancy firm name2020-12-31LEE CPA AUDIT GROUP
Accountancy firm EIN2020-12-31814637885
2019 : NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$2,140
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$2,282
Total income from all sources (including contributions)2019-12-31$493,961
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$65,961
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$39,990
Value of total corrective distributions2019-12-31$2,140
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$91,726
Value of total assets at end of year2019-12-31$2,602,418
Value of total assets at beginning of year2019-12-31$2,174,560
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$23,831
Total interest from all sources2019-12-31$5,512
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$400,000
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$91,726
Participant contributions at end of year2019-12-31$71,877
Participant contributions at beginning of year2019-12-31$104,691
Participant contributions at end of year2019-12-31$1,270
Participant contributions at beginning of year2019-12-31$2,979
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$428,000
Value of net assets at end of year (total assets less liabilities)2019-12-31$2,600,278
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$2,172,278
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$23,831
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$2,529,271
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$2,066,890
Interest on participant loans2019-12-31$5,512
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$396,723
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$39,990
Liabilities. Value of benefit claims payable at end of year2019-12-31$2,140
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$2,282
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31LEE CPA AUDIT GROUP
Accountancy firm EIN2019-12-31814637885

Form 5500 Responses for NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN

2022: NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: NIBBELINK MASONRY CONSTRUCTION CORP. 401(K) PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number500544-01
Policy instance 1
Insurance contract or identification number500544-01
Number of Individuals Covered24
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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number500544-01
Policy instance 1
Insurance contract or identification number500544-01
Number of Individuals Covered24
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?Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number500544-01
Policy instance 1
Insurance contract or identification number500544-01
Number of Individuals Covered23
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number500544-01
Policy instance 1
Insurance contract or identification number500544-01
Number of Individuals Covered30
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?Yes
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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