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LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 401k Plan overview

Plan NameLNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN
Plan identification number 001

LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Money purchase (other than target benefit)
  • 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

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

Company Name:LYNNVILLE NATIONAL BANK
Employer identification number (EIN):350482724
NAIC Classification:522110
NAIC Description:Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01JOHN HALEY2023-09-27
0012021-01-01BRADLEY PEMBERTON2022-06-30 BRADLEY PEMBERTON2022-06-30
0012020-01-01JOHN HALEY2021-05-24 JOHN HALEY2021-05-24
0012019-01-01JOHN HALEY2020-02-10 JOHN HALEY2020-02-10
0012018-01-01JOHN HALEY2019-02-19 JOHN HALEY2019-02-19
0012017-01-01JOHN HALEY2018-09-18 JOHN HALEY2018-09-18
0012016-01-01JOHN HALEY2017-07-24 JOHN HALEY2017-07-24
0012015-01-01JOHN HALEY2016-07-27 JOHN HALEY2016-07-27
0012014-01-01JOHN T. HALEY
0012013-01-01JOHN HALEY JOHN HALEY2014-07-21
0012012-01-01JOHN HALEY JOHN HALEY2013-07-26
0012011-01-01JOHN HALEY
0012010-01-01JOHN HALEY
0012009-01-01JOHN HALEY

Plan Statistics for LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN

401k plan membership statisitcs for LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN

Measure Date Value
2014: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0143
Total number of active participants reported on line 7a of the Form 55002014-01-0137
Number of retired or separated participants receiving benefits2014-01-012
Number of other retired or separated participants entitled to future benefits2014-01-017
Total of all active and inactive participants2014-01-0146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0146
Number of participants with account balances2014-01-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-0113
2013: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0144
Total number of active participants reported on line 7a of the Form 55002013-01-0138
Number of retired or separated participants receiving benefits2013-01-012
Number of other retired or separated participants entitled to future benefits2013-01-016
Total of all active and inactive participants2013-01-0146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0146
Number of participants with account balances2013-01-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-0118
2012: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0146
Total number of active participants reported on line 7a of the Form 55002012-01-0138
Number of retired or separated participants receiving benefits2012-01-012
Number of other retired or separated participants entitled to future benefits2012-01-016
Total of all active and inactive participants2012-01-0146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0146
Number of participants with account balances2012-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-0112
2011: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0144
Total number of active participants reported on line 7a of the Form 55002011-01-0135
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-019
Total of all active and inactive participants2011-01-0144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0144
Number of participants with account balances2011-01-0144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0142
Total number of active participants reported on line 7a of the Form 55002010-01-0139
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-018
Total of all active and inactive participants2010-01-0147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0147
Number of participants with account balances2010-01-0147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0143
Total number of active participants reported on line 7a of the Form 55002009-01-0138
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-016
Total of all active and inactive participants2009-01-0144
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0144
Number of participants with account balances2009-01-0144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN

Measure Date Value
2014 : LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total income from all sources2014-12-31$609,830
Expenses. Total of all expenses incurred2014-12-31$148,098
Benefits paid (including direct rollovers)2014-12-31$147,747
Total plan assets at end of year2014-12-31$5,582,246
Total plan assets at beginning of year2014-12-31$5,120,514
Value of fidelity bond covering the plan2014-12-31$2,000,000
Total contributions received or receivable from participants2014-12-31$138,848
Expenses. Other expenses not covered elsewhere2014-12-31$351
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$347,207
Net income (gross income less expenses)2014-12-31$461,732
Net plan assets at end of year (total assets less liabilities)2014-12-31$5,582,246
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$5,120,514
Assets. Value of participant loans2014-12-31$52,011
Total contributions received or receivable from employer(s)2014-12-31$123,775
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Funding deficiency by the employer to the plan for this plan year2014-12-31$0
Minimum employer required contribution for this plan year2014-12-31$0
Amount contributed by the employer to the plan for this plan year2014-12-31$0
2013 : LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$140
Total income from all sources2013-12-31$1,141,361
Expenses. Total of all expenses incurred2013-12-31$169,553
Benefits paid (including direct rollovers)2013-12-31$169,116
Total plan assets at end of year2013-12-31$5,120,514
Total plan assets at beginning of year2013-12-31$4,148,566
Value of fidelity bond covering the plan2013-12-31$2,000,000
Total contributions received or receivable from participants2013-12-31$136,038
Expenses. Other expenses not covered elsewhere2013-12-31$437
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$883,660
Net income (gross income less expenses)2013-12-31$971,808
Net plan assets at end of year (total assets less liabilities)2013-12-31$5,120,514
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$4,148,566
Assets. Value of participant loans2013-12-31$53,617
Total contributions received or receivable from employer(s)2013-12-31$121,663
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Funding deficiency by the employer to the plan for this plan year2013-12-31$0
Minimum employer required contribution for this plan year2013-12-31$0
Amount contributed by the employer to the plan for this plan year2013-12-31$0
2012 : LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$20,721
Total income from all sources2012-12-31$667,260
Expenses. Total of all expenses incurred2012-12-31$252,486
Benefits paid (including direct rollovers)2012-12-31$249,979
Total plan assets at end of year2012-12-31$4,148,566
Total plan assets at beginning of year2012-12-31$3,713,071
Value of fidelity bond covering the plan2012-12-31$2,000,000
Total contributions received or receivable from participants2012-12-31$142,155
Expenses. Other expenses not covered elsewhere2012-12-31$419
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$417,817
Net income (gross income less expenses)2012-12-31$414,774
Net plan assets at end of year (total assets less liabilities)2012-12-31$4,148,566
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$3,713,071
Assets. Value of participant loans2012-12-31$74,451
Total contributions received or receivable from employer(s)2012-12-31$107,288
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$2,088
Funding deficiency by the employer to the plan for this plan year2012-12-31$0
Minimum employer required contribution for this plan year2012-12-31$0
Amount contributed by the employer to the plan for this plan year2012-12-31$0
2011 : LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$1,497
Total income from all sources2011-12-31$127,736
Expenses. Total of all expenses incurred2011-12-31$160,160
Benefits paid (including direct rollovers)2011-12-31$159,838
Total plan assets at end of year2011-12-31$3,713,071
Total plan assets at beginning of year2011-12-31$3,743,998
Value of fidelity bond covering the plan2011-12-31$2,000,000
Total contributions received or receivable from participants2011-12-31$128,966
Expenses. Other expenses not covered elsewhere2011-12-31$322
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-119,709
Net income (gross income less expenses)2011-12-31$-32,424
Net plan assets at end of year (total assets less liabilities)2011-12-31$3,713,071
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$3,743,998
Assets. Value of participant loans2011-12-31$56,037
Total contributions received or receivable from employer(s)2011-12-31$118,479
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Funding deficiency by the employer to the plan for this plan year2011-12-31$0
Minimum employer required contribution for this plan year2011-12-31$0
Amount contributed by the employer to the plan for this plan year2011-12-31$0
2010 : LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$32
Total income from all sources2010-12-31$643,988
Expenses. Total of all expenses incurred2010-12-31$211,753
Benefits paid (including direct rollovers)2010-12-31$211,447
Total plan assets at end of year2010-12-31$3,743,998
Total plan assets at beginning of year2010-12-31$3,311,731
Value of fidelity bond covering the plan2010-12-31$2,000,000
Total contributions received or receivable from participants2010-12-31$125,631
Expenses. Other expenses not covered elsewhere2010-12-31$306
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$399,547
Net income (gross income less expenses)2010-12-31$432,235
Net plan assets at end of year (total assets less liabilities)2010-12-31$3,743,998
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$3,311,731
Assets. Value of participant loans2010-12-31$51,313
Total contributions received or receivable from employer(s)2010-12-31$118,810
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Funding deficiency by the employer to the plan for this plan year2010-12-31$0
Minimum employer required contribution for this plan year2010-12-31$0
Amount contributed by the employer to the plan for this plan year2010-12-31$0
2009 : LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year2009-12-31$0
Minimum employer required contribution for this plan year2009-12-31$0
Amount contributed by the employer to the plan for this plan year2009-12-31$0

Form 5500 Responses for LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN

2014: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: LNB COMMUNITY BANK CASH OR DEFERRED PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-711467
Policy instance 1
Insurance contract or identification numberGA-711467
Number of Individuals Covered45
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $13,503
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,503
Insurance broker organization code?3
Insurance broker nameINVESTMENT PROFESSIONALS INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-711467
Policy instance 1
Insurance contract or identification numberGA-711467
Number of Individuals Covered42
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $11,280
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,280
Insurance broker organization code?3
Insurance broker nameINVESTMENT PROFESSIONALS INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-711467
Policy instance 1
Insurance contract or identification numberGA-711467
Number of Individuals Covered40
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,718
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,718
Insurance broker organization code?3
Insurance broker nameINVESTMENT PROFESSIONALS INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-711467
Policy instance 1
Insurance contract or identification numberGA-711467
Number of Individuals Covered44
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $9,464
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-711467
Policy instance 1
Insurance contract or identification numberGA-711467
Number of Individuals Covered47
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $8,005
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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