BERMACK, CHAMPION, & LEWINE has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BERMACK, CHAMPION, & LEWINE 401(K) PLAN
| Measure | Date | Value |
|---|
| 2014: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 9 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 5 |
| Number of retired or separated participants receiving benefits | 2014-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-07-01 | 4 |
| Total of all active and inactive participants | 2014-07-01 | 9 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-07-01 | 0 |
| Total participants | 2014-07-01 | 9 |
| Number of participants with account balances | 2014-07-01 | 9 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-07-01 | 1 |
| 2013: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 9 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 5 |
| Number of retired or separated participants receiving benefits | 2013-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-07-01 | 5 |
| Total of all active and inactive participants | 2013-07-01 | 10 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-07-01 | 0 |
| Total participants | 2013-07-01 | 10 |
| Number of participants with account balances | 2013-07-01 | 10 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-07-01 | 0 |
| 2012: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 9 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 5 |
| Number of retired or separated participants receiving benefits | 2012-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-07-01 | 5 |
| Total of all active and inactive participants | 2012-07-01 | 10 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-07-01 | 0 |
| Total participants | 2012-07-01 | 10 |
| Number of participants with account balances | 2012-07-01 | 5 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-07-01 | 2 |
| 2011: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 9 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 5 |
| Number of retired or separated participants receiving benefits | 2011-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-07-01 | 4 |
| Total of all active and inactive participants | 2011-07-01 | 9 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-07-01 | 0 |
| Total participants | 2011-07-01 | 9 |
| Number of participants with account balances | 2011-07-01 | 5 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-07-01 | 2 |
| 2010: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 10 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 7 |
| Number of retired or separated participants receiving benefits | 2010-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-07-01 | 2 |
| Total of all active and inactive participants | 2010-07-01 | 9 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-07-01 | 0 |
| Total participants | 2010-07-01 | 9 |
| Number of participants with account balances | 2010-07-01 | 9 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-07-01 | 0 |
| 2009: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 10 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 8 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 2 |
| Total of all active and inactive participants | 2009-07-01 | 10 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-07-01 | 0 |
| Total participants | 2009-07-01 | 10 |
| Number of participants with account balances | 2009-07-01 | 10 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-07-01 | 0 |
| Measure | Date | Value |
|---|
| 2015 : BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2015 401k financial data |
|---|
| Transfers to/from the plan | 2015-06-30 | $0 |
| Total income from all sources | 2015-06-30 | $111,783 |
| Expenses. Total of all expenses incurred | 2015-06-30 | $19,919 |
| Benefits paid (including direct rollovers) | 2015-06-30 | $19,869 |
| Total plan assets at end of year | 2015-06-30 | $1,228,501 |
| Total plan assets at beginning of year | 2015-06-30 | $1,136,637 |
| Value of fidelity bond covering the plan | 2015-06-30 | $125,000 |
| Total contributions received or receivable from participants | 2015-06-30 | $28,464 |
| Expenses. Other expenses not covered elsewhere | 2015-06-30 | $50 |
| Contributions received from other sources (not participants or employers) | 2015-06-30 | $0 |
| Other income received | 2015-06-30 | $75,862 |
| Net income (gross income less expenses) | 2015-06-30 | $91,864 |
| Net plan assets at end of year (total assets less liabilities) | 2015-06-30 | $1,228,501 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-06-30 | $1,136,637 |
| Assets. Value of participant loans | 2015-06-30 | $9,466 |
| Total contributions received or receivable from employer(s) | 2015-06-30 | $7,457 |
| Value of certain deemed distributions of participant loans | 2015-06-30 | $0 |
| Value of corrective distributions | 2015-06-30 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2015-06-30 | $0 |
| Minimum employer required contribution for this plan year | 2015-06-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2015-06-30 | $0 |
| 2014 : BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2014 401k financial data |
|---|
| Transfers to/from the plan | 2014-06-30 | $0 |
| Total income from all sources | 2014-06-30 | $241,747 |
| Expenses. Total of all expenses incurred | 2014-06-30 | $46,614 |
| Benefits paid (including direct rollovers) | 2014-06-30 | $45,000 |
| Total plan assets at end of year | 2014-06-30 | $1,136,637 |
| Total plan assets at beginning of year | 2014-06-30 | $941,504 |
| Value of fidelity bond covering the plan | 2014-06-30 | $100,000 |
| Total contributions received or receivable from participants | 2014-06-30 | $24,844 |
| Expenses. Other expenses not covered elsewhere | 2014-06-30 | $0 |
| Contributions received from other sources (not participants or employers) | 2014-06-30 | $0 |
| Other income received | 2014-06-30 | $210,692 |
| Net income (gross income less expenses) | 2014-06-30 | $195,133 |
| Net plan assets at end of year (total assets less liabilities) | 2014-06-30 | $1,136,637 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-06-30 | $941,504 |
| Assets. Value of participant loans | 2014-06-30 | $0 |
| Total contributions received or receivable from employer(s) | 2014-06-30 | $6,211 |
| Value of certain deemed distributions of participant loans | 2014-06-30 | $0 |
| Value of corrective distributions | 2014-06-30 | $1,614 |
| Funding deficiency by the employer to the plan for this plan year | 2014-06-30 | $0 |
| Minimum employer required contribution for this plan year | 2014-06-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2014-06-30 | $0 |
| 2013 : BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2013 401k financial data |
|---|
| Transfers to/from the plan | 2013-06-30 | $0 |
| Total income from all sources | 2013-06-30 | $198,614 |
| Expenses. Total of all expenses incurred | 2013-06-30 | $0 |
| Benefits paid (including direct rollovers) | 2013-06-30 | $0 |
| Total plan assets at end of year | 2013-06-30 | $941,504 |
| Total plan assets at beginning of year | 2013-06-30 | $742,890 |
| Value of fidelity bond covering the plan | 2013-06-30 | $100,000 |
| Total contributions received or receivable from participants | 2013-06-30 | $25,194 |
| Expenses. Other expenses not covered elsewhere | 2013-06-30 | $0 |
| Contributions received from other sources (not participants or employers) | 2013-06-30 | $0 |
| Other income received | 2013-06-30 | $167,373 |
| Net income (gross income less expenses) | 2013-06-30 | $198,614 |
| Net plan assets at end of year (total assets less liabilities) | 2013-06-30 | $941,504 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-06-30 | $742,890 |
| Assets. Value of participant loans | 2013-06-30 | $0 |
| Total contributions received or receivable from employer(s) | 2013-06-30 | $6,047 |
| Value of certain deemed distributions of participant loans | 2013-06-30 | $0 |
| Value of corrective distributions | 2013-06-30 | $0 |
| 2012 : BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2012 401k financial data |
|---|
| Transfers to/from the plan | 2012-06-30 | $0 |
| Total income from all sources | 2012-06-30 | $-3,384 |
| Expenses. Total of all expenses incurred | 2012-06-30 | $30,000 |
| Benefits paid (including direct rollovers) | 2012-06-30 | $30,000 |
| Total plan assets at end of year | 2012-06-30 | $742,890 |
| Total plan assets at beginning of year | 2012-06-30 | $776,274 |
| Value of fidelity bond covering the plan | 2012-06-30 | $100,000 |
| Total contributions received or receivable from participants | 2012-06-30 | $28,324 |
| Expenses. Other expenses not covered elsewhere | 2012-06-30 | $0 |
| Contributions received from other sources (not participants or employers) | 2012-06-30 | $0 |
| Other income received | 2012-06-30 | $-38,532 |
| Net income (gross income less expenses) | 2012-06-30 | $-33,384 |
| Net plan assets at end of year (total assets less liabilities) | 2012-06-30 | $742,890 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-06-30 | $776,274 |
| Assets. Value of participant loans | 2012-06-30 | $73 |
| Total contributions received or receivable from employer(s) | 2012-06-30 | $6,824 |
| Value of certain deemed distributions of participant loans | 2012-06-30 | $0 |
| Value of corrective distributions | 2012-06-30 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2012-06-30 | $0 |
| Minimum employer required contribution for this plan year | 2012-06-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2012-06-30 | $0 |
| 2011 : BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2011 401k financial data |
|---|
| Transfers to/from the plan | 2011-06-30 | $0 |
| Total income from all sources | 2011-06-30 | $236,064 |
| Expenses. Total of all expenses incurred | 2011-06-30 | $65,036 |
| Benefits paid (including direct rollovers) | 2011-06-30 | $64,644 |
| Total plan assets at end of year | 2011-06-30 | $776,274 |
| Total plan assets at beginning of year | 2011-06-30 | $605,246 |
| Value of fidelity bond covering the plan | 2011-06-30 | $100,000 |
| Total contributions received or receivable from participants | 2011-06-30 | $46,949 |
| Expenses. Other expenses not covered elsewhere | 2011-06-30 | $0 |
| Contributions received from other sources (not participants or employers) | 2011-06-30 | $0 |
| Other income received | 2011-06-30 | $177,646 |
| Net income (gross income less expenses) | 2011-06-30 | $171,028 |
| Net plan assets at end of year (total assets less liabilities) | 2011-06-30 | $776,274 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-06-30 | $605,246 |
| Assets. Value of participant loans | 2011-06-30 | $73 |
| Total contributions received or receivable from employer(s) | 2011-06-30 | $11,469 |
| Value of certain deemed distributions of participant loans | 2011-06-30 | $0 |
| Value of corrective distributions | 2011-06-30 | $392 |
| Funding deficiency by the employer to the plan for this plan year | 2011-06-30 | $0 |
| Minimum employer required contribution for this plan year | 2011-06-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2011-06-30 | $0 |
| 2010 : BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2010 401k financial data |
|---|
| Transfers to/from the plan | 2010-06-30 | $0 |
| Total income from all sources | 2010-06-30 | $141,880 |
| Expenses. Total of all expenses incurred | 2010-06-30 | $1,016 |
| Benefits paid (including direct rollovers) | 2010-06-30 | $0 |
| Total plan assets at end of year | 2010-06-30 | $605,246 |
| Total plan assets at beginning of year | 2010-06-30 | $464,382 |
| Value of fidelity bond covering the plan | 2010-06-30 | $100,000 |
| Total contributions received or receivable from participants | 2010-06-30 | $51,020 |
| Expenses. Other expenses not covered elsewhere | 2010-06-30 | $448 |
| Contributions received from other sources (not participants or employers) | 2010-06-30 | $0 |
| Other income received | 2010-06-30 | $78,322 |
| Net income (gross income less expenses) | 2010-06-30 | $140,864 |
| Net plan assets at end of year (total assets less liabilities) | 2010-06-30 | $605,246 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-06-30 | $464,382 |
| Assets. Value of participant loans | 2010-06-30 | $73 |
| Total contributions received or receivable from employer(s) | 2010-06-30 | $12,538 |
| Value of certain deemed distributions of participant loans | 2010-06-30 | $0 |
| Value of corrective distributions | 2010-06-30 | $568 |
| Funding deficiency by the employer to the plan for this plan year | 2010-06-30 | $0 |
| Minimum employer required contribution for this plan year | 2010-06-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2010-06-30 | $0 |
| 2014: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Submission has been amended | No |
| 2014-07-01 | This submission is the final filing | No |
| 2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-07-01 | Plan is a collectively bargained plan | No |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan funding arrangement – Trust | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Submission has been amended | No |
| 2013-07-01 | This submission is the final filing | No |
| 2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-07-01 | Plan is a collectively bargained plan | No |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan funding arrangement – Trust | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Submission has been amended | No |
| 2012-07-01 | This submission is the final filing | No |
| 2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-07-01 | Plan is a collectively bargained plan | No |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan funding arrangement – Trust | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Submission has been amended | No |
| 2011-07-01 | This submission is the final filing | No |
| 2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-07-01 | Plan is a collectively bargained plan | No |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan funding arrangement – Trust | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2010 form 5500 responses |
|---|
| 2010-07-01 | Type of plan entity | Single employer plan |
| 2010-07-01 | Submission has been amended | No |
| 2010-07-01 | This submission is the final filing | No |
| 2010-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-07-01 | Plan is a collectively bargained plan | No |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan funding arrangement – Trust | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: BERMACK, CHAMPION, & LEWINE 401(K) PLAN 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | Submission has been amended | No |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-07-01 | Plan is a collectively bargained plan | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan funding arrangement – Trust | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-031028 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-031028 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $2,271 | | 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 $2,271 | | Insurance broker organization code? | 3 | | Insurance broker name | IIAA AGCY ADMIN SVCS |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-031028 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-031028 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $2,042 | | 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 $2,042 | | Insurance broker organization code? | 3 | | Insurance broker name | IIAA AGCY ADMIN SVCS |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-031028 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-031028 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $1,590 | | 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 $1,590 | | Insurance broker organization code? | 3 | | Insurance broker name | IIAA AGCY ADMINISTRATIVE SVCS |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-031028 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-031028 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $1,456 | | 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-031028 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-031028 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $1,359 | | 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 $1,359 | | Insurance broker organization code? | 3 | | Insurance broker name | IIAA AGCY ADMINISTRATIVE SVCS |
|
