Schedule A
- Row 1
- Filing Id
- 91037320205822
- Form Id
- 22199339
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 40372060099040002
- Ins Broker 01 Name
- SUNAMERICA SECURITIES INC
- Ins Broker 01 Street Addr
- 2800 N CENTRAL STE 2100
- Ins Broker 01 City
- PHOENIX
- Ins Broker 01 State
- AZ
- Ins Broker 01 ZIP Code
- 850041050
- Ins Broker Comm Pd 01 Amount
- $7,659
- Ins Broker Fees Pd 01 Amount
- $0
- Row 2
- Ins Carrier Name: NATIONWIDE LIFE INSURANCE COMPANY
- Filing Id
- 91037320205822
- Form Id
- 22199339
- Schedule A EIN
- 75-2341780
- Schedule A Plan Num
- 001
- Schedule A Plan Year Begin Date
- 2000-01-01
- Schedule A Tax Period
- 20001231
- Ins Carrier Name
- NATIONWIDE LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 31-4156830
- Ins Carrier Naic Code
- 66869
- Ins Contract Num
- 396-00011
- Ins Prsn Covered End of year Count
- 47
- Ins Policy From Date
- 2000-01-01
- Ins Policy To Date
- 2000-12-31
- Ins Broker Comm Total Amount
- $7,659
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $265,251
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $0
- Wlfr Acquis Cost Amount
- $0
Schedule D
- Row 1
- Filing Id
- 91037320205822
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 40372060099040003
- Row 2
- Filing Id
- 91037320205822
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- DREYFUS S & P 500 INDEX FUND
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $150
- Row 3
- Filing Id
- 91037320205822
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- DREYFUS PREMIER THIRD CENTURY FUND
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $19,894
- Row 4
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 1
- Row Num
- 10
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- DREYFUS APPRECIATION FUND INC
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $14,720
- Row 5
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 2
- Row Num
- 11
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- DREYFUS BALANCED FUND
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $1,743
- Row 6
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 3
- Row Num
- 12
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- FED HIGH YIELD TRUST
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $3,119
- Row 7
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 4
- Row Num
- 13
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- JANUS WORLDWIDE FUND
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $19,835
- Row 8
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 5
- Row Num
- 14
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- NEU BER GENSEIS FUND TC
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $104
- Row 9
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 1
- Page Row Num
- 6
- Row Num
- 15
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- NATIONWIDE S&P500 INDEX FUND SC
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $13,214
- Row 10
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 1
- Row Num
- 16
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- PERSONAL PORTFOLIO SERIES I
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $2,267
- Row 11
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 2
- Row Num
- 17
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- INVESCO DYNAMICS FUND IC
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $11,721
- Row 12
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 3
- Row Num
- 18
- Image Form Id
- 40372060099040003
- DFE P1 Plan Interest End of year 01 Amount
- $0
- Row 13
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 4
- Row Num
- 19
- Image Form Id
- 40372060099040003
- DFE P1 Plan Interest End of year 01 Amount
- $0
- Row 14
- Filing Id
- 91037320205822
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 3
- Row Num
- 2
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- JANUS FUND
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $32,781
- Row 15
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 5
- Row Num
- 20
- Image Form Id
- 40372060099040003
- DFE P1 Plan Interest End of year 01 Amount
- $0
- Row 16
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 2
- Page Row Num
- 6
- Row Num
- 21
- Image Form Id
- 40372060099040003
- DFE P1 Plan Interest End of year 01 Amount
- $0
- Row 17
- Filing Id
- 91037320205822
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 4
- Row Num
- 3
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- JANUS TWENTY FUND
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $110,436
- Row 18
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 4
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- NATIONWIDE BOND FUND CLASS D
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $567
- Row 19
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 5
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- NATIONWIDE FUND CLASS D
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $5,613
- Row 20
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 3
- Row Num
- 6
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- NATIONWIDE USGOVT BOND FUND CLASS D
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $35
- Row 21
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 4
- Row Num
- 7
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- NATIONWIDE MONEY MARKET FUND
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $3,577
- Row 22
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 5
- Row Num
- 8
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- NATIONWIDE SMALL COMPANY FUND
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $253
- Row 23
- Filing Id
- 91037320205822
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 6
- Row Num
- 9
- Image Form Id
- 40372060099040003
- DFE P1 Entity 01 Name
- AMERICAN CENTURY INCOME AND GROWTH
- DFE P1 Spons 01 Name
- NATIONWIDE LIFE INSURANCE COMPANY
- DFE P1 Plan 01 EIN Plan number
- 314156830000
- DFE P1 Entity 01 Code
- P
- DFE P1 Plan Interest End of year 01 Amount
- $37,102