401k Plan data: AMERICAN BANK 401(K) PROFIT SHARING PLAN plan

AMERICAN BANK 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan Name	AMERICAN BANK 401(K) PROFIT SHARING PLAN
Plan identification number	002

AMERICAN BANK 401(K) PROFIT SHARING PLAN Benefits

401k Plan Type

Defined 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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

AMERICAN BANK has sponsored the creation of one or more 401k plans.

Company Name: AMERICAN BANK

Employer identification number (EIN): 810305954

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan AMERICAN BANK 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-01-01 PLAN SPONSOR 2023-08-09
002 2021-01-01 PLAN SPONSOR 2022-09-07
002 2020-01-01 MEGAN YOUNG 2021-10-13 MEGAN YOUNG 2021-10-13
002 2019-01-01 GEORGIA K. LUKKES 2020-08-27
002 2018-01-01 GEORGIA K LUKKES 2019-06-05 GEORGIA K LUKKES 2019-06-05
002 2017-01-01 BEVERLY A. KOVASH 2018-06-21 BEVERLY A. KVOASH 2018-06-21
002 2016-01-01 BEVERLY A. KOVASH 2017-05-25
002 2015-01-01 BEVERLY A. KOVASH 2016-06-24
002 2014-01-01 BEVERLY A. KOVASH
002 2013-01-01 BEVERLY A. KOVASH
002 2012-01-01 BEVERLY A. KOVASH BEVERLY A KOVASH 2013-06-12
002 2011-01-01 BEVERLY A. KOVASH
002 2010-01-01 BEVERLY A. KOVASH
002 2009-01-01 BEVERLY A. KOVASH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2022-01-01	PLAN SPONSOR	2023-08-09
002	2021-01-01	PLAN SPONSOR	2022-09-07
002	2020-01-01	MEGAN YOUNG	2021-10-13	MEGAN YOUNG	2021-10-13
002	2019-01-01	GEORGIA K. LUKKES	2020-08-27
002	2018-01-01	GEORGIA K LUKKES	2019-06-05	GEORGIA K LUKKES	2019-06-05
002	2017-01-01	BEVERLY A. KOVASH	2018-06-21	BEVERLY A. KVOASH	2018-06-21
002	2016-01-01	BEVERLY A. KOVASH	2017-05-25
002	2015-01-01	BEVERLY A. KOVASH	2016-06-24
002	2014-01-01	BEVERLY A. KOVASH
002	2013-01-01	BEVERLY A. KOVASH
002	2012-01-01	BEVERLY A. KOVASH		BEVERLY A KOVASH	2013-06-12
002	2011-01-01	BEVERLY A. KOVASH
002	2010-01-01	BEVERLY A. KOVASH
002	2009-01-01	BEVERLY A. KOVASH

Plan Statistics for AMERICAN BANK 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for AMERICAN BANK 401(K) PROFIT SHARING PLAN

Measure Date Value
2014: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 67
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 32
Total of all active and inactive participants 2014-01-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 100
Number of participants with account balances 2014-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 3
2013: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 91
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 72
Number of retired or separated participants receiving benefits 2013-01-01 1
Number of other retired or separated participants entitled to future benefits 2013-01-01 30
Total of all active and inactive participants 2013-01-01 103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 103
Number of participants with account balances 2013-01-01 94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 4
2012: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 86
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 66
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 25
Total of all active and inactive participants 2012-01-01 91
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 91
Number of participants with account balances 2012-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 3
2011: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 89
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 74
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 12
Total of all active and inactive participants 2011-01-01 86
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 86
Number of participants with account balances 2011-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 92
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 76
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 13
Total of all active and inactive participants 2010-01-01 89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 89
Number of participants with account balances 2010-01-01 89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 103
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 78
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 17
Total of all active and inactive participants 2009-01-01 95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 95
Number of participants with account balances 2009-01-01 90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 5

Measure	Date	Value
2014: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	67
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	32
Total of all active and inactive participants	2014-01-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	100
Number of participants with account balances	2014-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	3
2013: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	91
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	72
Number of retired or separated participants receiving benefits	2013-01-01	1
Number of other retired or separated participants entitled to future benefits	2013-01-01	30
Total of all active and inactive participants	2013-01-01	103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	103
Number of participants with account balances	2013-01-01	94
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	4
2012: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	86
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	66
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	25
Total of all active and inactive participants	2012-01-01	91
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	91
Number of participants with account balances	2012-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	3
2011: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	89
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	74
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	12
Total of all active and inactive participants	2011-01-01	86
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	86
Number of participants with account balances	2011-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	92
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	76
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	13
Total of all active and inactive participants	2010-01-01	89
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	89
Number of participants with account balances	2010-01-01	89
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	103
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	78
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	17
Total of all active and inactive participants	2009-01-01	95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	95
Number of participants with account balances	2009-01-01	90
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	5

Financial Data on AMERICAN BANK 401(K) PROFIT SHARING PLAN

Measure	Date	Value
2014 : AMERICAN BANK 401(K) PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$595,140
Expenses. Total of all expenses incurred	2014-12-31	$761,854
Benefits paid (including direct rollovers)	2014-12-31	$757,675
Total plan assets at end of year	2014-12-31	$5,982,091
Total plan assets at beginning of year	2014-12-31	$6,148,805
Value of fidelity bond covering the plan	2014-12-31	$1,500,000
Total contributions received or receivable from participants	2014-12-31	$224,701
Contributions received from other sources (not participants or employers)	2014-12-31	$17,434
Other income received	2014-12-31	$229,380
Net income (gross income less expenses)	2014-12-31	$-166,714
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$5,982,091
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$6,148,805
Total contributions received or receivable from employer(s)	2014-12-31	$123,625
Value of corrective distributions	2014-12-31	$3,729
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$450
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : AMERICAN BANK 401(K) PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$921,341
Expenses. Total of all expenses incurred	2013-12-31	$730,402
Benefits paid (including direct rollovers)	2013-12-31	$726,700
Total plan assets at end of year	2013-12-31	$6,148,805
Total plan assets at beginning of year	2013-12-31	$5,957,866
Value of fidelity bond covering the plan	2013-12-31	$1,500,000
Total contributions received or receivable from participants	2013-12-31	$244,088
Contributions received from other sources (not participants or employers)	2013-12-31	$97,642
Other income received	2013-12-31	$454,892
Net income (gross income less expenses)	2013-12-31	$190,939
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$6,148,805
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$5,957,866
Assets. Value of participant loans	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$124,719
Value of corrective distributions	2013-12-31	$3,352
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$350
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : AMERICAN BANK 401(K) PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$746,486
Expenses. Total of all expenses incurred	2012-12-31	$268,857
Benefits paid (including direct rollovers)	2012-12-31	$267,037
Total plan assets at end of year	2012-12-31	$5,957,866
Total plan assets at beginning of year	2012-12-31	$5,480,237
Value of fidelity bond covering the plan	2012-12-31	$1,500,000
Total contributions received or receivable from participants	2012-12-31	$250,066
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$358,058
Net income (gross income less expenses)	2012-12-31	$477,629
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$5,957,866
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$5,480,237
Assets. Value of participant loans	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$138,362
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$1,520
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$300
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : AMERICAN BANK 401(K) PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$278,173
Expenses. Total of all expenses incurred	2011-12-31	$73,936
Benefits paid (including direct rollovers)	2011-12-31	$70,113
Total plan assets at end of year	2011-12-31	$5,480,237
Total plan assets at beginning of year	2011-12-31	$5,276,000
Value of fidelity bond covering the plan	2011-12-31	$1,500,000
Total contributions received or receivable from participants	2011-12-31	$259,491
Expenses. Other expenses not covered elsewhere	2011-12-31	$200
Contributions received from other sources (not participants or employers)	2011-12-31	$6,856
Other income received	2011-12-31	$-139,317
Net income (gross income less expenses)	2011-12-31	$204,237
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$5,480,237
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$5,276,000
Assets. Value of participant loans	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$151,143
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$3,623
Funding deficiency by the employer to the plan for this plan year	2011-12-31	$0
Minimum employer required contribution for this plan year	2011-12-31	$0
Amount contributed by the employer to the plan for this plan year	2011-12-31	$0
2010 : AMERICAN BANK 401(K) PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$39
Total income from all sources	2010-12-31	$811,697
Expenses. Total of all expenses incurred	2010-12-31	$285,842
Benefits paid (including direct rollovers)	2010-12-31	$285,592
Total plan assets at end of year	2010-12-31	$5,276,000
Total plan assets at beginning of year	2010-12-31	$4,750,106
Value of fidelity bond covering the plan	2010-12-31	$1,500,000
Total contributions received or receivable from participants	2010-12-31	$279,158
Expenses. Other expenses not covered elsewhere	2010-12-31	$250
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$344,180
Net income (gross income less expenses)	2010-12-31	$525,855
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$5,276,000
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$4,750,106
Assets. Value of participant loans	2010-12-31	$0
Total contributions received or receivable from employer(s)	2010-12-31	$188,359
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
2009 : AMERICAN BANK 401(K) PROFIT SHARING PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year	2009-12-31	$0
Minimum employer required contribution for this plan year	2009-12-31	$0
Amount contributed by the employer to the plan for this plan year	2009-12-31	$0

Form 5500 Responses for AMERICAN BANK 401(K) PROFIT SHARING PLAN

2014: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: AMERICAN BANK 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-710468

Policy instance

Insurance contract or identification number	GA-710468
Number of Individuals Covered	94
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $29,887
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $29,887
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-710468

Policy instance

Insurance contract or identification number	GA-710468
Number of Individuals Covered	94
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $24,026
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $24,026
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGY OF MT

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-710468

Policy instance

Insurance contract or identification number	GA-710468
Number of Individuals Covered	71
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $22,144
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $22,144
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGY OF MT

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-710468

Policy instance

Insurance contract or identification number	GA-710468
Number of Individuals Covered	86
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $20,783
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 number

GA-710468

Policy instance

Insurance contract or identification number	GA-710468
Number of Individuals Covered	89
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $17,109
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Broker	USD $17,109
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGCY OF MT

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Company Name:	AMERICAN BANK
Employer identification number (EIN):	810305954
NAIC Classification:	522110
NAIC Description:	Commercial Banking