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GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 401k Plan overview

Plan NameGREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN
Plan identification number 001

GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN Benefits

401k Plan TypeDefined 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
  • 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

GREAT PLAINS PEDIATRICS, INC. has sponsored the creation of one or more 401k plans.

Company Name:GREAT PLAINS PEDIATRICS, INC.
Employer identification number (EIN):730928263
NAIC Classification:621111
NAIC Description:Offices of Physicians (except Mental Health Specialists)

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012019-04-01
0012018-04-01
0012017-04-01
0012016-04-01
0012015-04-01EDNA SOLITARIO, M.D.2016-06-16
0012014-04-01EDNA SOLITARIO, M.D,
0012013-04-01EDNA SOLITARIO, M.D,
0012012-04-01EDNA SOLITARIO, M.D,
0012011-04-01EDNA SOLITARIO, M.D,
0012010-04-01EDNA SOLITARIO, M.D,

Plan Statistics for GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN

401k plan membership statisitcs for GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN

Measure Date Value
2014: GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-017
Total number of active participants reported on line 7a of the Form 55002014-04-017
Number of retired or separated participants receiving benefits2014-04-010
Number of other retired or separated participants entitled to future benefits2014-04-010
Total of all active and inactive participants2014-04-017
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-04-010
Total participants2014-04-017
Number of participants with account balances2014-04-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-04-010
2013: GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-019
Total number of active participants reported on line 7a of the Form 55002013-04-019
Number of retired or separated participants receiving benefits2013-04-010
Number of other retired or separated participants entitled to future benefits2013-04-010
Total of all active and inactive participants2013-04-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-04-010
Total participants2013-04-019
Number of participants with account balances2013-04-017
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-04-012
2012: GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-019
Total number of active participants reported on line 7a of the Form 55002012-04-017
Number of retired or separated participants receiving benefits2012-04-010
Number of other retired or separated participants entitled to future benefits2012-04-012
Total of all active and inactive participants2012-04-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-04-010
Total participants2012-04-019
Number of participants with account balances2012-04-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-04-011
2011: GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-0111
Total number of active participants reported on line 7a of the Form 55002011-04-018
Number of retired or separated participants receiving benefits2011-04-010
Number of other retired or separated participants entitled to future benefits2011-04-010
Total of all active and inactive participants2011-04-018
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-04-010
Total participants2011-04-018
Number of participants with account balances2011-04-018
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-04-011
2010: GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-04-0111
Total number of active participants reported on line 7a of the Form 55002010-04-0110
Number of retired or separated participants receiving benefits2010-04-011
Total of all active and inactive participants2010-04-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-04-010
Total participants2010-04-0111
Number of participants with account balances2010-04-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-04-010

Financial Data on GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN

Measure Date Value
2015 : GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2015 401k financial data
Transfers to/from the plan2015-03-31$0
Total plan liabilities at end of year2015-03-31$0
Total plan liabilities at beginning of year2015-03-31$0
Total income from all sources2015-03-31$177,294
Expenses. Total of all expenses incurred2015-03-31$6,251
Benefits paid (including direct rollovers)2015-03-31$0
Total plan assets at end of year2015-03-31$2,609,025
Total plan assets at beginning of year2015-03-31$2,437,982
Value of fidelity bond covering the plan2015-03-31$300,000
Total contributions received or receivable from participants2015-03-31$0
Expenses. Other expenses not covered elsewhere2015-03-31$0
Contributions received from other sources (not participants or employers)2015-03-31$0
Other income received2015-03-31$63,408
Noncash contributions received2015-03-31$0
Net income (gross income less expenses)2015-03-31$171,043
Net plan assets at end of year (total assets less liabilities)2015-03-31$2,609,025
Net plan assets at beginning of year (total assets less liabilities)2015-03-31$2,437,982
Assets. Value of assets in partnership/joint-venture interests2015-03-31$0
Total contributions received or receivable from employer(s)2015-03-31$113,886
Value of certain deemed distributions of participant loans2015-03-31$0
Value of corrective distributions2015-03-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-03-31$6,251
2014 : GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2014 401k financial data
Transfers to/from the plan2014-03-31$0
Total plan liabilities at end of year2014-03-31$0
Total plan liabilities at beginning of year2014-03-31$0
Total income from all sources2014-03-31$245,300
Expenses. Total of all expenses incurred2014-03-31$7,202
Benefits paid (including direct rollovers)2014-03-31$569
Total plan assets at end of year2014-03-31$2,437,982
Total plan assets at beginning of year2014-03-31$2,199,884
Value of fidelity bond covering the plan2014-03-31$300,000
Total contributions received or receivable from participants2014-03-31$0
Expenses. Other expenses not covered elsewhere2014-03-31$0
Contributions received from other sources (not participants or employers)2014-03-31$0
Other income received2014-03-31$194,813
Noncash contributions received2014-03-31$0
Net income (gross income less expenses)2014-03-31$238,098
Net plan assets at end of year (total assets less liabilities)2014-03-31$2,437,982
Net plan assets at beginning of year (total assets less liabilities)2014-03-31$2,199,884
Assets. Value of assets in partnership/joint-venture interests2014-03-31$70,737
Total contributions received or receivable from employer(s)2014-03-31$50,487
Value of certain deemed distributions of participant loans2014-03-31$0
Value of corrective distributions2014-03-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-03-31$6,633
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-03-31$0
2013 : GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2013 401k financial data
Transfers to/from the plan2013-03-31$0
Total plan liabilities at end of year2013-03-31$0
Total plan liabilities at beginning of year2013-03-31$0
Total income from all sources2013-03-31$328,216
Expenses. Total of all expenses incurred2013-03-31$30,896
Benefits paid (including direct rollovers)2013-03-31$25,453
Total plan assets at end of year2013-03-31$2,199,884
Total plan assets at beginning of year2013-03-31$1,902,564
Value of fidelity bond covering the plan2013-03-31$300,000
Total contributions received or receivable from participants2013-03-31$0
Expenses. Other expenses not covered elsewhere2013-03-31$0
Contributions received from other sources (not participants or employers)2013-03-31$0
Other income received2013-03-31$217,446
Noncash contributions received2013-03-31$0
Net income (gross income less expenses)2013-03-31$297,320
Net plan assets at end of year (total assets less liabilities)2013-03-31$2,199,884
Net plan assets at beginning of year (total assets less liabilities)2013-03-31$1,902,564
Assets. Value of assets in partnership/joint-venture interests2013-03-31$164,100
Total contributions received or receivable from employer(s)2013-03-31$110,770
Value of certain deemed distributions of participant loans2013-03-31$0
Value of corrective distributions2013-03-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-03-31$5,443
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-03-31$0
2012 : GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2012 401k financial data
Transfers to/from the plan2012-03-31$0
Total plan liabilities at end of year2012-03-31$0
Total plan liabilities at beginning of year2012-03-31$0
Total income from all sources2012-03-31$186,303
Expenses. Total of all expenses incurred2012-03-31$196,722
Benefits paid (including direct rollovers)2012-03-31$196,607
Total plan assets at end of year2012-03-31$1,902,564
Total plan assets at beginning of year2012-03-31$1,912,983
Value of fidelity bond covering the plan2012-03-31$300,000
Total contributions received or receivable from participants2012-03-31$0
Expenses. Other expenses not covered elsewhere2012-03-31$0
Contributions received from other sources (not participants or employers)2012-03-31$0
Other income received2012-03-31$79,090
Noncash contributions received2012-03-31$0
Net income (gross income less expenses)2012-03-31$-10,419
Net plan assets at end of year (total assets less liabilities)2012-03-31$1,902,564
Net plan assets at beginning of year (total assets less liabilities)2012-03-31$1,912,983
Assets. Value of assets in partnership/joint-venture interests2012-03-31$81,111
Total contributions received or receivable from employer(s)2012-03-31$107,213
Value of certain deemed distributions of participant loans2012-03-31$0
Value of corrective distributions2012-03-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-03-31$115
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-03-31$0
2011 : GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2011 401k financial data
Transfers to/from the plan2011-03-31$0
Total plan liabilities at end of year2011-03-31$0
Total plan liabilities at beginning of year2011-03-31$0
Total income from all sources2011-03-31$229,249
Expenses. Total of all expenses incurred2011-03-31$18,960
Benefits paid (including direct rollovers)2011-03-31$9,482
Total plan assets at end of year2011-03-31$1,912,983
Total plan assets at beginning of year2011-03-31$1,702,694
Value of fidelity bond covering the plan2011-03-31$300,000
Total contributions received or receivable from participants2011-03-31$0
Expenses. Other expenses not covered elsewhere2011-03-31$9,478
Contributions received from other sources (not participants or employers)2011-03-31$0
Other income received2011-03-31$68,753
Noncash contributions received2011-03-31$0
Net income (gross income less expenses)2011-03-31$210,289
Net plan assets at end of year (total assets less liabilities)2011-03-31$1,912,983
Net plan assets at beginning of year (total assets less liabilities)2011-03-31$1,702,694
Assets. Value of assets in partnership/joint-venture interests2011-03-31$81,111
Total contributions received or receivable from employer(s)2011-03-31$160,496
Value of certain deemed distributions of participant loans2011-03-31$0
Value of corrective distributions2011-03-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-03-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-03-31$0

Form 5500 Responses for GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN

2014: GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planNo
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan funding arrangement – TrustYes
2014-04-01Plan benefit arrangement – InsuranceYes
2014-04-01Plan benefit arrangement - TrustYes
2013: GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planNo
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan funding arrangement – TrustYes
2013-04-01Plan benefit arrangement – InsuranceYes
2013-04-01Plan benefit arrangement - TrustYes
2012: GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planNo
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan funding arrangement – TrustYes
2012-04-01Plan benefit arrangement – InsuranceYes
2012-04-01Plan benefit arrangement - TrustYes
2011: GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planNo
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan funding arrangement – TrustYes
2011-04-01Plan benefit arrangement – InsuranceYes
2011-04-01Plan benefit arrangement - TrustYes
2010: GREAT PLAINS PEDIATRICS, INC. RETIREMENT PLAN 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01Submission has been amendedNo
2010-04-01This submission is the final filingNo
2010-04-01This return/report is a short plan year return/report (less than 12 months)No
2010-04-01Plan is a collectively bargained planNo
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan funding arrangement – TrustYes
2010-04-01Plan benefit arrangement – InsuranceYes
2010-04-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberVARIOUS
Policy instance 2
Insurance contract or identification numberVARIOUS
Number of Individuals Covered2
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Are there contracts with allocated funds for individual policies?Yes
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
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameMORGAN STANLEY
HARTFORD LIFE & ANNUITY (National Association of Insurance Commissioners NAIC id number: 71153 )
Policy contract number102 U01964405
Policy instance 3
Insurance contract or identification number102 U01964405
Number of Individuals Covered1
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Are there contracts with allocated funds for individual policies?Yes
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
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Total amount of commissions paid to insurance brokerUSD $130,807
Total amount of fees paid to insurance companyUSD $18,680
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,868,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Amount paid for insurance broker fees18680
Insurance broker nameMORGAN STANLEY
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number0585618
Policy instance 1
Insurance contract or identification number0585618
Number of Individuals Covered1
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker namePERRY ALLEN WARREN
HARTFORD LIFE & ANNUITY (National Association of Insurance Commissioners NAIC id number: 71153 )
Policy contract number102 U01964405
Policy instance 1
Insurance contract or identification number102 U01964405
Number of Individuals Covered1
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameMORGAN STANLEY
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number0585618
Policy instance 2
Insurance contract or identification number0585618
Number of Individuals Covered1
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker namePERRY ALLEN WARREN
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberVARIOUS
Policy instance 3
Insurance contract or identification numberVARIOUS
Number of Individuals Covered2
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
Total amount of commissions paid to insurance brokerUSD $3,041
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
Commission paid to Insurance BrokerUSD $3,041
Insurance broker organization code?3
Insurance broker nameMORGAN STANLEY
HARTFORD LIFE & ANNUITY (National Association of Insurance Commissioners NAIC id number: 71153 )
Policy contract number102 U01964405
Policy instance 1
Insurance contract or identification number102 U01964405
Number of Individuals Covered1
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameMORGAN STANLEY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberVARIOUS
Policy instance 3
Insurance contract or identification numberVARIOUS
Number of Individuals Covered2
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $4,293
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
Commission paid to Insurance BrokerUSD $4,293
Insurance broker organization code?3
Insurance broker nameMORGAN STANLEY
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number0585618
Policy instance 2
Insurance contract or identification number0585618
Number of Individuals Covered1
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker namePERRY ALLEN WARREN
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberVARIOUS
Policy instance 1
Insurance contract or identification numberVARIOUS
Number of Individuals Covered2
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number0585618
Policy instance 2
Insurance contract or identification number0585618
Number of Individuals Covered1
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
HARTFORD LIFE & ANNUITY (National Association of Insurance Commissioners NAIC id number: 71153 )
Policy contract number102 U01964405
Policy instance 3
Insurance contract or identification number102 U01964405
Number of Individuals Covered1
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberVARIOUS
Policy instance 1
Insurance contract or identification numberVARIOUS
Number of Individuals Covered2
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $340,202
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
METLIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 87726 )
Policy contract number0585618
Policy instance 2
Insurance contract or identification number0585618
Number of Individuals Covered1
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $1,826
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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
HARTFORD LIFE & ANNUITY (National Association of Insurance Commissioners NAIC id number: 71153 )
Policy contract number102 U01964405
Policy instance 3
Insurance contract or identification number102 U01964405
Number of Individuals Covered1
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $26,247
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?Yes
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

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