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Form 5500 Annual Return Report — Schedule A Supplement


Form 5500 Series Schedule A is an attachment to Form 5500 that is required if any plan services are provided by an insurance company.

To complete Part I of Schedule A for RecordkeeperDirect-Multifund® plans, you will need this information:

  • Line 1(a), Name of insurance carrier: Great-West Life & Annuity Insurance Company of New York
  • Line 1(b), EIN: 93-1225432
  • Line 1(c), NAIC code: 60214
  • Line 1(d), Contract or identification number: enter the Contract Number provided on the plan’s Group Fixed and Variable Deferred Annuity Contract.
  • Line 1(e), Approximate number of persons covered at end of policy or contract year: enter the estimated number of participants covered by the contract at the end of the plan year.
  • Line 1(f) and (g), Policy or contract year: enter the start and end dates for the plan year.

To complete the rest of the form, use the information found in the report “Form 5500 Annual Return Report — Schedule A” in the "Reports & Analysis" section of the website.