HAITAI, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN
| Measure | Date | Value |
|---|
| 2014: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 31 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 26 |
| Number of retired or separated participants receiving benefits | 2014-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 1 |
| Total of all active and inactive participants | 2014-10-01 | 27 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-10-01 | 0 |
| Total participants | 2014-10-01 | 27 |
| Number of participants with account balances | 2014-10-01 | 27 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-10-01 | 0 |
| 2013: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 32 |
| Number of retired or separated participants receiving benefits | 2013-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 6 |
| Total of all active and inactive participants | 2013-10-01 | 38 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-10-01 | 0 |
| Total participants | 2013-10-01 | 38 |
| Number of participants with account balances | 2013-10-01 | 30 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-10-01 | 1 |
| 2012: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 40 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 33 |
| Number of retired or separated participants receiving benefits | 2012-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-10-01 | 6 |
| Total of all active and inactive participants | 2012-10-01 | 39 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-10-01 | 0 |
| Total participants | 2012-10-01 | 39 |
| Number of participants with account balances | 2012-10-01 | 33 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-10-01 | 1 |
| 2011: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 43 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 36 |
| Number of retired or separated participants receiving benefits | 2011-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-10-01 | 9 |
| Total of all active and inactive participants | 2011-10-01 | 45 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-10-01 | 0 |
| Total participants | 2011-10-01 | 45 |
| Number of participants with account balances | 2011-10-01 | 28 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-10-01 | 2 |
| 2010: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-10-01 | 44 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-10-01 | 39 |
| Number of retired or separated participants receiving benefits | 2010-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-10-01 | 6 |
| Total of all active and inactive participants | 2010-10-01 | 45 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-10-01 | 0 |
| Total participants | 2010-10-01 | 45 |
| Number of participants with account balances | 2010-10-01 | 28 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-10-01 | 2 |
| 2009: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 41 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 33 |
| Number of retired or separated participants receiving benefits | 2009-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-10-01 | 7 |
| Total of all active and inactive participants | 2009-10-01 | 40 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-10-01 | 1 |
| Total participants | 2009-10-01 | 41 |
| Number of participants with account balances | 2009-10-01 | 27 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-10-01 | 1 |
| Measure | Date | Value |
|---|
| 2015 : TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-09-30 | $116,740 |
| Expenses. Total of all expenses incurred | 2015-09-30 | $80,570 |
| Benefits paid (including direct rollovers) | 2015-09-30 | $79,407 |
| Total plan assets at end of year | 2015-09-30 | $1,537,562 |
| Total plan assets at beginning of year | 2015-09-30 | $1,501,392 |
| Value of fidelity bond covering the plan | 2015-09-30 | $100,000 |
| Total contributions received or receivable from participants | 2015-09-30 | $93,338 |
| Expenses. Other expenses not covered elsewhere | 2015-09-30 | $1,163 |
| Other income received | 2015-09-30 | $-826 |
| Net income (gross income less expenses) | 2015-09-30 | $36,170 |
| Net plan assets at end of year (total assets less liabilities) | 2015-09-30 | $1,537,562 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-09-30 | $1,501,392 |
| Assets. Value of participant loans | 2015-09-30 | $93,859 |
| Total contributions received or receivable from employer(s) | 2015-09-30 | $24,228 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2015-09-30 | $0 |
| 2014 : TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2014 401k financial data |
|---|
| Transfers to/from the plan | 2014-09-30 | $0 |
| Total income from all sources | 2014-09-30 | $226,107 |
| Expenses. Total of all expenses incurred | 2014-09-30 | $33,200 |
| Benefits paid (including direct rollovers) | 2014-09-30 | $32,506 |
| Total plan assets at end of year | 2014-09-30 | $1,501,392 |
| Total plan assets at beginning of year | 2014-09-30 | $1,308,485 |
| Value of fidelity bond covering the plan | 2014-09-30 | $100,000 |
| Total contributions received or receivable from participants | 2014-09-30 | $75,516 |
| Expenses. Other expenses not covered elsewhere | 2014-09-30 | $694 |
| Contributions received from other sources (not participants or employers) | 2014-09-30 | $0 |
| Other income received | 2014-09-30 | $129,867 |
| Net income (gross income less expenses) | 2014-09-30 | $192,907 |
| Net plan assets at end of year (total assets less liabilities) | 2014-09-30 | $1,501,392 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-09-30 | $1,308,485 |
| Assets. Value of participant loans | 2014-09-30 | $58,938 |
| Total contributions received or receivable from employer(s) | 2014-09-30 | $20,724 |
| Value of certain deemed distributions of participant loans | 2014-09-30 | $0 |
| Value of corrective distributions | 2014-09-30 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2014-09-30 | $0 |
| Minimum employer required contribution for this plan year | 2014-09-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2014-09-30 | $0 |
| 2013 : TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2013 401k financial data |
|---|
| Transfers to/from the plan | 2013-09-30 | $0 |
| Total income from all sources | 2013-09-30 | $241,086 |
| Expenses. Total of all expenses incurred | 2013-09-30 | $46,715 |
| Benefits paid (including direct rollovers) | 2013-09-30 | $45,671 |
| Total plan assets at end of year | 2013-09-30 | $1,308,485 |
| Total plan assets at beginning of year | 2013-09-30 | $1,114,114 |
| Value of fidelity bond covering the plan | 2013-09-30 | $100,000 |
| Total contributions received or receivable from participants | 2013-09-30 | $70,494 |
| Expenses. Other expenses not covered elsewhere | 2013-09-30 | $1,044 |
| Contributions received from other sources (not participants or employers) | 2013-09-30 | $0 |
| Other income received | 2013-09-30 | $150,519 |
| Net income (gross income less expenses) | 2013-09-30 | $194,371 |
| Net plan assets at end of year (total assets less liabilities) | 2013-09-30 | $1,308,485 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-09-30 | $1,114,114 |
| Assets. Value of participant loans | 2013-09-30 | $85,114 |
| Total contributions received or receivable from employer(s) | 2013-09-30 | $20,073 |
| Value of certain deemed distributions of participant loans | 2013-09-30 | $0 |
| Value of corrective distributions | 2013-09-30 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2013-09-30 | $0 |
| Minimum employer required contribution for this plan year | 2013-09-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2013-09-30 | $0 |
| 2012 : TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2012 401k financial data |
|---|
| Transfers to/from the plan | 2012-09-30 | $0 |
| Total income from all sources | 2012-09-30 | $231,847 |
| Expenses. Total of all expenses incurred | 2012-09-30 | $16,610 |
| Benefits paid (including direct rollovers) | 2012-09-30 | $15,694 |
| Total plan assets at end of year | 2012-09-30 | $1,114,114 |
| Total plan assets at beginning of year | 2012-09-30 | $898,877 |
| Value of fidelity bond covering the plan | 2012-09-30 | $100,000 |
| Total contributions received or receivable from participants | 2012-09-30 | $71,436 |
| Expenses. Other expenses not covered elsewhere | 2012-09-30 | $916 |
| Contributions received from other sources (not participants or employers) | 2012-09-30 | $0 |
| Other income received | 2012-09-30 | $141,832 |
| Net income (gross income less expenses) | 2012-09-30 | $215,237 |
| Net plan assets at end of year (total assets less liabilities) | 2012-09-30 | $1,114,114 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-09-30 | $898,877 |
| Assets. Value of participant loans | 2012-09-30 | $97,885 |
| Total contributions received or receivable from employer(s) | 2012-09-30 | $18,579 |
| Value of certain deemed distributions of participant loans | 2012-09-30 | $0 |
| Value of corrective distributions | 2012-09-30 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2012-09-30 | $0 |
| Minimum employer required contribution for this plan year | 2012-09-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2012-09-30 | $0 |
| 2011 : TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2011 401k financial data |
|---|
| Transfers to/from the plan | 2011-09-30 | $0 |
| Total income from all sources | 2011-09-30 | $94,446 |
| Expenses. Total of all expenses incurred | 2011-09-30 | $85,172 |
| Benefits paid (including direct rollovers) | 2011-09-30 | $84,198 |
| Total plan assets at end of year | 2011-09-30 | $898,877 |
| Total plan assets at beginning of year | 2011-09-30 | $889,603 |
| Value of fidelity bond covering the plan | 2011-09-30 | $100,000 |
| Total contributions received or receivable from participants | 2011-09-30 | $76,719 |
| Expenses. Other expenses not covered elsewhere | 2011-09-30 | $974 |
| Contributions received from other sources (not participants or employers) | 2011-09-30 | $0 |
| Other income received | 2011-09-30 | $-2,626 |
| Net income (gross income less expenses) | 2011-09-30 | $9,274 |
| Net plan assets at end of year (total assets less liabilities) | 2011-09-30 | $898,877 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-09-30 | $889,603 |
| Assets. Value of participant loans | 2011-09-30 | $72,446 |
| Total contributions received or receivable from employer(s) | 2011-09-30 | $20,353 |
| Value of certain deemed distributions of participant loans | 2011-09-30 | $0 |
| Value of corrective distributions | 2011-09-30 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2011-09-30 | $0 |
| Minimum employer required contribution for this plan year | 2011-09-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2011-09-30 | $0 |
| 2014: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Submission has been amended | No |
| 2014-10-01 | This submission is the final filing | No |
| 2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-10-01 | Plan is a collectively bargained plan | No |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan funding arrangement – Trust | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Submission has been amended | No |
| 2013-10-01 | This submission is the final filing | No |
| 2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-10-01 | Plan is a collectively bargained plan | No |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan funding arrangement – Trust | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Submission has been amended | No |
| 2012-10-01 | This submission is the final filing | No |
| 2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-10-01 | Plan is a collectively bargained plan | No |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan funding arrangement – Trust | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Submission has been amended | No |
| 2011-10-01 | This submission is the final filing | No |
| 2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-10-01 | Plan is a collectively bargained plan | No |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan funding arrangement – Trust | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2010 form 5500 responses |
|---|
| 2010-10-01 | Type of plan entity | Single employer plan |
| 2010-10-01 | Submission has been amended | No |
| 2010-10-01 | This submission is the final filing | No |
| 2010-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-10-01 | Plan is a collectively bargained plan | No |
| 2010-10-01 | Plan funding arrangement – Insurance | Yes |
| 2010-10-01 | Plan funding arrangement – Trust | Yes |
| 2010-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: TRUSTEES OF HAITAI GLOBAL, INC 401(K) PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Submission has been amended | No |
| 2009-10-01 | This submission is the final filing | No |
| 2009-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-10-01 | Plan is a collectively bargained plan | No |
| 2009-10-01 | Plan funding arrangement – Insurance | Yes |
| 2009-10-01 | Plan funding arrangement – Trust | Yes |
| 2009-10-01 | Plan benefit arrangement – Insurance | Yes |
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-007016 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-007016 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $3,397 | | 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 $3,397 | | Insurance broker organization code? | 3 | | Insurance broker name | CIFS INC |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-007016 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-007016 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $2,928 | | 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 $2,928 | | Insurance broker organization code? | 3 | | Insurance broker name | CIFS INC |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-007016 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-007016 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $2,514 | | 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 $2,514 | | Insurance broker organization code? | 3 | | Insurance broker name | CITY INSURANCE SERVICES |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-007016 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-007016 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $2,292 | | 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-007016 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-007016 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $2,277 | | 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 |
|
