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SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 401k Plan overview

Plan NameSOUTH JERSEY GLASS CO. INC. 401(K) PLAN
Plan identification number 001

SOUTH JERSEY GLASS CO. INC. 401(K) 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.

401k Sponsoring company profile

SOUTH JERSEY GLASS CO. INC. has sponsored the creation of one or more 401k plans.

Company Name:SOUTH JERSEY GLASS CO. INC.
Employer identification number (EIN):210699654
NAIC Classification:442291
NAIC Description:Window Treatment Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SOUTH JERSEY GLASS CO. INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01MATTHEW J. MUFALLI2023-10-04 MATTHEW J. MUFALLI2023-10-04
0012021-01-01
0012020-01-01JODI L. TRIVELLINI2021-06-14 DENISE R DORRIS2021-06-14
0012019-01-01DENISE DORRIS2020-06-30
0012018-11-01DENISE R DORRIS2019-06-12 DENISE R DORRIS2019-06-12
0012017-11-01DENISE R DORRIS2019-03-28 DENISE R DORRIS2019-03-28
0012016-11-01JOSEPH C. MUFALLI2018-04-12 MATTHEW MUFALLI2018-04-12
0012015-11-01JODITRIV2017-04-03 DDORRIS2017-04-03
0012014-11-01DENISE DORRIS DENISE DORRIS2016-04-08
0012013-11-01DENISE DORRIS DENISE2015-03-30
0012012-11-01JOSEPH MUFALLI
0012011-11-01JOSEPH MUFALLI JOSEPH MUFALLI2013-03-19
0012010-11-01JOSEPH MUFALLI
0012009-11-01JOSEPH MUFALLI

Plan Statistics for SOUTH JERSEY GLASS CO. INC. 401(K) PLAN

401k plan membership statisitcs for SOUTH JERSEY GLASS CO. INC. 401(K) PLAN

Measure Date Value
2022: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01139
Total number of active participants reported on line 7a of the Form 55002022-01-01151
Number of other retired or separated participants entitled to future benefits2022-01-0118
Total of all active and inactive participants2022-01-01169
Total participants2022-01-01169
Number of participants with account balances2022-01-0197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-013
2014: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-11-0150
Total number of active participants reported on line 7a of the Form 55002014-11-0138
Number of retired or separated participants receiving benefits2014-11-010
Number of other retired or separated participants entitled to future benefits2014-11-016
Total of all active and inactive participants2014-11-0144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-11-010
Total participants2014-11-0144
Number of participants with account balances2014-11-0138
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-11-012
2013: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-11-0137
Total number of active participants reported on line 7a of the Form 55002013-11-0140
Number of retired or separated participants receiving benefits2013-11-010
Number of other retired or separated participants entitled to future benefits2013-11-015
Total of all active and inactive participants2013-11-0145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-11-010
Total participants2013-11-0145
Number of participants with account balances2013-11-0133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-11-010
2012: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-11-0124
Total number of active participants reported on line 7a of the Form 55002012-11-0122
Number of retired or separated participants receiving benefits2012-11-010
Number of other retired or separated participants entitled to future benefits2012-11-015
Total of all active and inactive participants2012-11-0127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-11-010
Total participants2012-11-0127
Number of participants with account balances2012-11-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-11-010
2011: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-11-0123
Total number of active participants reported on line 7a of the Form 55002011-11-0119
Number of retired or separated participants receiving benefits2011-11-010
Number of other retired or separated participants entitled to future benefits2011-11-014
Total of all active and inactive participants2011-11-0123
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-11-010
Total participants2011-11-0123
Number of participants with account balances2011-11-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-11-010
2010: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-11-0124
Total number of active participants reported on line 7a of the Form 55002010-11-0119
Number of retired or separated participants receiving benefits2010-11-010
Number of other retired or separated participants entitled to future benefits2010-11-016
Total of all active and inactive participants2010-11-0125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-11-010
Total participants2010-11-0125
Number of participants with account balances2010-11-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-11-011
2009: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-11-0125
Total number of active participants reported on line 7a of the Form 55002009-11-0121
Number of retired or separated participants receiving benefits2009-11-010
Number of other retired or separated participants entitled to future benefits2009-11-013
Total of all active and inactive participants2009-11-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-11-010
Total participants2009-11-0124
Number of participants with account balances2009-11-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-11-012

Financial Data on SOUTH JERSEY GLASS CO. INC. 401(K) PLAN

Measure Date Value
2022 : SOUTH JERSEY GLASS CO. INC. 401(K) 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$0
Total income from all sources (including contributions)2022-12-31$-538,157
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$231,633
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$183,805
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$1,063,360
Value of total assets at end of year2022-12-31$8,922,754
Value of total assets at beginning of year2022-12-31$9,692,544
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$47,828
Total interest from all sources2022-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$430,000
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$620,932
Participant contributions at end of year2022-12-31$51,928
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$132,146
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-769,790
Value of net assets at end of year (total assets less liabilities)2022-12-31$8,922,754
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$9,692,544
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 pooled separate accounts at end of year2022-12-31$8,843,648
Value of interest in pooled separate accounts at beginning of year2022-12-31$9,692,544
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$1,214
Net investment gain/loss from pooled separate accounts2022-12-31$-1,601,517
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
Contributions received in cash from employer2022-12-31$310,282
Employer contributions (assets) at end of year2022-12-31$25,964
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$183,805
Contract administrator fees2022-12-31$47,828
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-12-31No
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 name2022-12-31LONG & ASSOCIATES P.C.
Accountancy firm EIN2022-12-31352009629
2015 : SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2015 401k financial data
Transfers to/from the plan2015-10-31$0
Total income from all sources2015-10-31$478,295
Expenses. Total of all expenses incurred2015-10-31$6,952
Benefits paid (including direct rollovers)2015-10-31$1,022
Total plan assets at end of year2015-10-31$4,250,985
Total plan assets at beginning of year2015-10-31$3,779,642
Value of fidelity bond covering the plan2015-10-31$500,000
Total contributions received or receivable from participants2015-10-31$189,137
Expenses. Other expenses not covered elsewhere2015-10-31$0
Contributions received from other sources (not participants or employers)2015-10-31$0
Other income received2015-10-31$127,585
Net income (gross income less expenses)2015-10-31$471,343
Net plan assets at end of year (total assets less liabilities)2015-10-31$4,250,985
Net plan assets at beginning of year (total assets less liabilities)2015-10-31$3,779,642
Assets. Value of participant loans2015-10-31$0
Total contributions received or receivable from employer(s)2015-10-31$161,573
Value of certain deemed distributions of participant loans2015-10-31$0
Value of corrective distributions2015-10-31$5,930
2014 : SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2014 401k financial data
Transfers to/from the plan2014-10-31$0
Total income from all sources2014-10-31$673,185
Expenses. Total of all expenses incurred2014-10-31$21,938
Benefits paid (including direct rollovers)2014-10-31$472
Total plan assets at end of year2014-10-31$3,779,642
Total plan assets at beginning of year2014-10-31$3,128,395
Value of fidelity bond covering the plan2014-10-31$500,000
Total contributions received or receivable from participants2014-10-31$157,975
Expenses. Other expenses not covered elsewhere2014-10-31$0
Contributions received from other sources (not participants or employers)2014-10-31$0
Other income received2014-10-31$379,081
Net income (gross income less expenses)2014-10-31$651,247
Net plan assets at end of year (total assets less liabilities)2014-10-31$3,779,642
Net plan assets at beginning of year (total assets less liabilities)2014-10-31$3,128,395
Assets. Value of participant loans2014-10-31$0
Total contributions received or receivable from employer(s)2014-10-31$136,129
Value of certain deemed distributions of participant loans2014-10-31$0
Value of corrective distributions2014-10-31$21,466
Funding deficiency by the employer to the plan for this plan year2014-10-31$0
Minimum employer required contribution for this plan year2014-10-31$0
Amount contributed by the employer to the plan for this plan year2014-10-31$0
2013 : SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-10-31$0
Total income from all sources2013-10-31$883,454
Expenses. Total of all expenses incurred2013-10-31$160,365
Benefits paid (including direct rollovers)2013-10-31$135,054
Total plan assets at end of year2013-10-31$3,128,395
Total plan assets at beginning of year2013-10-31$2,405,306
Value of fidelity bond covering the plan2013-10-31$500,000
Total contributions received or receivable from participants2013-10-31$136,218
Expenses. Other expenses not covered elsewhere2013-10-31$0
Contributions received from other sources (not participants or employers)2013-10-31$0
Other income received2013-10-31$648,989
Net income (gross income less expenses)2013-10-31$723,089
Net plan assets at end of year (total assets less liabilities)2013-10-31$3,128,395
Net plan assets at beginning of year (total assets less liabilities)2013-10-31$2,405,306
Assets. Value of participant loans2013-10-31$0
Total contributions received or receivable from employer(s)2013-10-31$98,247
Value of certain deemed distributions of participant loans2013-10-31$0
Value of corrective distributions2013-10-31$25,311
Funding deficiency by the employer to the plan for this plan year2013-10-31$0
Minimum employer required contribution for this plan year2013-10-31$0
Amount contributed by the employer to the plan for this plan year2013-10-31$0
2012 : SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2012 401k financial data
Transfers to/from the plan2012-10-31$0
Total income from all sources2012-10-31$413,910
Expenses. Total of all expenses incurred2012-10-31$16,941
Benefits paid (including direct rollovers)2012-10-31$10,769
Total plan assets at end of year2012-10-31$2,405,306
Total plan assets at beginning of year2012-10-31$2,008,337
Value of fidelity bond covering the plan2012-10-31$500,000
Total contributions received or receivable from participants2012-10-31$98,422
Expenses. Other expenses not covered elsewhere2012-10-31$0
Contributions received from other sources (not participants or employers)2012-10-31$23,810
Other income received2012-10-31$207,646
Net income (gross income less expenses)2012-10-31$396,969
Net plan assets at end of year (total assets less liabilities)2012-10-31$2,405,306
Net plan assets at beginning of year (total assets less liabilities)2012-10-31$2,008,337
Assets. Value of participant loans2012-10-31$0
Total contributions received or receivable from employer(s)2012-10-31$84,032
Value of certain deemed distributions of participant loans2012-10-31$0
Value of corrective distributions2012-10-31$6,172
Funding deficiency by the employer to the plan for this plan year2012-10-31$0
Minimum employer required contribution for this plan year2012-10-31$0
Amount contributed by the employer to the plan for this plan year2012-10-31$0
2011 : SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-10-31$0
Total income from all sources2011-10-31$211,621
Expenses. Total of all expenses incurred2011-10-31$23,386
Benefits paid (including direct rollovers)2011-10-31$8,300
Total plan assets at end of year2011-10-31$2,008,337
Total plan assets at beginning of year2011-10-31$1,820,102
Value of fidelity bond covering the plan2011-10-31$500,000
Total contributions received or receivable from participants2011-10-31$102,509
Expenses. Other expenses not covered elsewhere2011-10-31$0
Contributions received from other sources (not participants or employers)2011-10-31$0
Other income received2011-10-31$12,811
Net income (gross income less expenses)2011-10-31$188,235
Net plan assets at end of year (total assets less liabilities)2011-10-31$2,008,337
Net plan assets at beginning of year (total assets less liabilities)2011-10-31$1,820,102
Assets. Value of participant loans2011-10-31$0
Total contributions received or receivable from employer(s)2011-10-31$96,301
Value of certain deemed distributions of participant loans2011-10-31$0
Value of corrective distributions2011-10-31$15,086
Funding deficiency by the employer to the plan for this plan year2011-10-31$0
Minimum employer required contribution for this plan year2011-10-31$0
Amount contributed by the employer to the plan for this plan year2011-10-31$0
2010 : SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2010 401k financial data
Funding deficiency by the employer to the plan for this plan year2010-10-31$0
Minimum employer required contribution for this plan year2010-10-31$0
Amount contributed by the employer to the plan for this plan year2010-10-31$0

Form 5500 Responses for SOUTH JERSEY GLASS CO. INC. 401(K) PLAN

2022: SOUTH JERSEY GLASS CO. INC. 401(K) 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 benefit arrangement – InsuranceYes
2014: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2014 form 5500 responses
2014-11-01Type of plan entitySingle employer plan
2014-11-01Submission has been amendedNo
2014-11-01This submission is the final filingNo
2014-11-01This return/report is a short plan year return/report (less than 12 months)No
2014-11-01Plan is a collectively bargained planNo
2014-11-01Plan funding arrangement – InsuranceYes
2014-11-01Plan funding arrangement – TrustYes
2014-11-01Plan benefit arrangement – InsuranceYes
2013: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2013 form 5500 responses
2013-11-01Type of plan entitySingle employer plan
2013-11-01Submission has been amendedNo
2013-11-01This submission is the final filingNo
2013-11-01This return/report is a short plan year return/report (less than 12 months)No
2013-11-01Plan is a collectively bargained planNo
2013-11-01Plan funding arrangement – InsuranceYes
2013-11-01Plan funding arrangement – TrustYes
2013-11-01Plan benefit arrangement – InsuranceYes
2012: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2012 form 5500 responses
2012-11-01Type of plan entitySingle employer plan
2012-11-01Submission has been amendedNo
2012-11-01This submission is the final filingNo
2012-11-01This return/report is a short plan year return/report (less than 12 months)No
2012-11-01Plan is a collectively bargained planNo
2012-11-01Plan funding arrangement – InsuranceYes
2012-11-01Plan funding arrangement – TrustYes
2012-11-01Plan benefit arrangement – InsuranceYes
2011: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2011 form 5500 responses
2011-11-01Type of plan entitySingle employer plan
2011-11-01Submission has been amendedNo
2011-11-01This submission is the final filingNo
2011-11-01This return/report is a short plan year return/report (less than 12 months)No
2011-11-01Plan is a collectively bargained planNo
2011-11-01Plan funding arrangement – InsuranceYes
2011-11-01Plan funding arrangement – TrustYes
2011-11-01Plan benefit arrangement – InsuranceYes
2010: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2010 form 5500 responses
2010-11-01Type of plan entitySingle employer plan
2010-11-01Submission has been amendedNo
2010-11-01This submission is the final filingNo
2010-11-01This return/report is a short plan year return/report (less than 12 months)No
2010-11-01Plan is a collectively bargained planNo
2010-11-01Plan funding arrangement – InsuranceYes
2010-11-01Plan funding arrangement – TrustYes
2010-11-01Plan benefit arrangement – InsuranceYes
2009: SOUTH JERSEY GLASS CO. INC. 401(K) PLAN 2009 form 5500 responses
2009-11-01Type of plan entitySingle employer plan
2009-11-01Submission has been amendedNo
2009-11-01This submission is the final filingNo
2009-11-01This return/report is a short plan year return/report (less than 12 months)No
2009-11-01Plan is a collectively bargained planNo
2009-11-01Plan funding arrangement – InsuranceYes
2009-11-01Plan funding arrangement – TrustYes
2009-11-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number149118
Policy instance 1
Insurance contract or identification number149118
Number of Individuals Covered101
Insurance policy start date2022-01-01
Insurance policy end date2022-01-01
Total amount of fees paid to insurance companyUSD $8,811
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?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
Amount paid for insurance broker fees8811
Additional information about fees paid to insurance brokerTPA OF RECORD
Insurance broker organization code?5
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-023415
Policy instance 1
Insurance contract or identification numberGA-023415
Number of Individuals Covered38
Insurance policy start date2014-11-01
Insurance policy end date2015-10-31
Total amount of commissions paid to insurance brokerUSD $20,069
Total amount of fees paid to insurance companyUSD $0
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?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
Commission paid to Insurance BrokerUSD $12,810
Insurance broker organization code?3
Insurance broker nameWELLS FARGO WEALTH BROKERAGE INS
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-023415
Policy instance 1
Insurance contract or identification numberGA-023415
Number of Individuals Covered33
Insurance policy start date2013-11-01
Insurance policy end date2014-10-31
Total amount of commissions paid to insurance brokerUSD $17,056
Total amount of fees paid to insurance companyUSD $0
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?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
Commission paid to Insurance BrokerUSD $17,056
Insurance broker organization code?3
Insurance broker nameWELLS FARGO ADVISORS INS AGENCY, LL
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-023415
Policy instance 1
Insurance contract or identification numberGA-023415
Number of Individuals Covered22
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $13,561
Total amount of fees paid to insurance companyUSD $0
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?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
Commission paid to Insurance BrokerUSD $13,561
Insurance broker organization code?3
Insurance broker nameWELLS FARGO ADVISORS INS AGY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-023415
Policy instance 1
Insurance contract or identification numberGA-023415
Number of Individuals Covered19
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $11,000
Total amount of fees paid to insurance companyUSD $0
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?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
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-023415
Policy instance 1
Insurance contract or identification numberGA-023415
Number of Individuals Covered24
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $10,216
Total amount of fees paid to insurance companyUSD $0
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?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

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