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PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 401k Plan overview

Plan NamePATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN
Plan identification number 001

PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • 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.
  • 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.
  • Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

PATRICK ENTERPRISES CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:PATRICK ENTERPRISES CORPORATION
Employer identification number (EIN):541269609
NAIC Classification:331200

Additional information about PATRICK ENTERPRISES CORPORATION

Jurisdiction of Incorporation: Virginia Secretary of State
Incorporation Date: 1984-02-28
Company Identification Number: 0252841
Legal Registered Office Address: PO BOX 10
P.O. BOX 10
PEMBROKE
United States of America (USA)
24136

More information about PATRICK ENTERPRISES CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-07-01SHANDA HESSE2024-01-25
0012021-07-01SHANDA HESSE2023-04-06
0012020-07-01SHANDA HESSE2021-12-16 SHANDA HESSE2021-12-16
0012019-07-01SHANDA HESSE2021-01-17 SHANDA HESSE2021-01-17
0012019-07-01SHANDA HESSE2021-01-17 SHANDA HESSE2021-01-17
0012018-07-01SHANDA HESSE2019-12-30 SHANDA HESSE2019-12-30
0012017-07-01SHANDA CONLEY2018-12-12 SHANDA CONLEY2018-12-12
0012016-07-01SHANDA CONLEY2017-11-28 SHANDA CONLEY2017-11-28
0012015-07-01SHANDA CONLEY2016-11-15 SHANDA CONLEY2016-11-15
0012014-07-01SHANDA CONLEY
0012013-07-01SHANDA CONLEY
0012012-07-01SHANDA CONLEY
0012011-07-01SHANDA CONLEY
0012009-07-01SHANDA CONLEY
0012006-07-01SHANDA CONLEY

Plan Statistics for PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN

401k plan membership statisitcs for PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN

Measure Date Value
2014: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-0143
Total number of active participants reported on line 7a of the Form 55002014-07-0127
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-0120
Total of all active and inactive participants2014-07-0147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-07-011
Total participants2014-07-0148
Number of participants with account balances2014-07-0147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-07-018
2013: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-0137
Total number of active participants reported on line 7a of the Form 55002013-07-0135
Number of retired or separated participants receiving benefits2013-07-010
Number of other retired or separated participants entitled to future benefits2013-07-0114
Total of all active and inactive participants2013-07-0149
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-07-010
Total participants2013-07-0149
Number of participants with account balances2013-07-0137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-07-015
2012: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-0134
Total number of active participants reported on line 7a of the Form 55002012-07-0122
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-0114
Total of all active and inactive participants2012-07-0136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-010
Total participants2012-07-0136
Number of participants with account balances2012-07-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-07-016
2011: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-0141
Total number of active participants reported on line 7a of the Form 55002011-07-0131
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-0110
Total of all active and inactive participants2011-07-0141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-07-010
Total participants2011-07-0141
Number of participants with account balances2011-07-0131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-07-013
2009: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-0137
Total number of active participants reported on line 7a of the Form 55002009-07-0118
Number of retired or separated participants receiving benefits2009-07-010
Number of other retired or separated participants entitled to future benefits2009-07-0114
Total of all active and inactive participants2009-07-0132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-07-010
Total participants2009-07-0132
Number of participants with account balances2009-07-0134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-07-015
2006: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2006 401k membership
Total participants, beginning-of-year2006-07-0133
Total number of active participants reported on line 7a of the Form 55002006-07-0126
Number of retired or separated participants receiving benefits2006-07-010
Number of other retired or separated participants entitled to future benefits2006-07-016
Total of all active and inactive participants2006-07-0132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2006-07-010
Total participants2006-07-0132
Number of participants with account balances2006-07-0132
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2006-07-012

Financial Data on PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN

Measure Date Value
2015 : PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2015 401k financial data
Transfers to/from the plan2015-06-30$0
Total income from all sources2015-06-30$161,267
Expenses. Total of all expenses incurred2015-06-30$207,356
Benefits paid (including direct rollovers)2015-06-30$206,852
Total plan assets at end of year2015-06-30$1,216,520
Total plan assets at beginning of year2015-06-30$1,262,609
Value of fidelity bond covering the plan2015-06-30$100,000
Total contributions received or receivable from participants2015-06-30$44,695
Expenses. Other expenses not covered elsewhere2015-06-30$504
Contributions received from other sources (not participants or employers)2015-06-30$11,008
Other income received2015-06-30$14,815
Net income (gross income less expenses)2015-06-30$-46,089
Net plan assets at end of year (total assets less liabilities)2015-06-30$1,216,520
Net plan assets at beginning of year (total assets less liabilities)2015-06-30$1,262,609
Assets. Value of participant loans2015-06-30$4,288
Total contributions received or receivable from employer(s)2015-06-30$90,749
Value of certain deemed distributions of participant loans2015-06-30$0
Value of corrective distributions2015-06-30$0
Funding deficiency by the employer to the plan for this plan year2015-06-30$0
Minimum employer required contribution for this plan year2015-06-30$0
Amount contributed by the employer to the plan for this plan year2015-06-30$0
2014 : PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2014 401k financial data
Transfers to/from the plan2014-06-30$0
Total income from all sources2014-06-30$261,409
Expenses. Total of all expenses incurred2014-06-30$64,039
Benefits paid (including direct rollovers)2014-06-30$63,617
Total plan assets at end of year2014-06-30$1,262,609
Total plan assets at beginning of year2014-06-30$1,065,239
Value of fidelity bond covering the plan2014-06-30$100,000
Total contributions received or receivable from participants2014-06-30$46,738
Expenses. Other expenses not covered elsewhere2014-06-30$422
Contributions received from other sources (not participants or employers)2014-06-30$0
Other income received2014-06-30$154,671
Net income (gross income less expenses)2014-06-30$197,370
Net plan assets at end of year (total assets less liabilities)2014-06-30$1,262,609
Net plan assets at beginning of year (total assets less liabilities)2014-06-30$1,065,239
Assets. Value of participant loans2014-06-30$6,055
Total contributions received or receivable from employer(s)2014-06-30$60,000
Value of certain deemed distributions of participant loans2014-06-30$0
Value of corrective distributions2014-06-30$0
Funding deficiency by the employer to the plan for this plan year2014-06-30$0
Minimum employer required contribution for this plan year2014-06-30$0
Amount contributed by the employer to the plan for this plan year2014-06-30$0
2013 : PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2013 401k financial data
Transfers to/from the plan2013-06-30$0
Total income from all sources2013-06-30$332,298
Expenses. Total of all expenses incurred2013-06-30$5,108
Benefits paid (including direct rollovers)2013-06-30$4,676
Total plan assets at end of year2013-06-30$1,065,248
Total plan assets at beginning of year2013-06-30$738,058
Value of fidelity bond covering the plan2013-06-30$100,000
Total contributions received or receivable from participants2013-06-30$46,298
Expenses. Other expenses not covered elsewhere2013-06-30$432
Contributions received from other sources (not participants or employers)2013-06-30$0
Other income received2013-06-30$71,000
Net income (gross income less expenses)2013-06-30$327,190
Net plan assets at end of year (total assets less liabilities)2013-06-30$1,065,248
Net plan assets at beginning of year (total assets less liabilities)2013-06-30$738,058
Assets. Value of participant loans2013-06-30$3,713
Total contributions received or receivable from employer(s)2013-06-30$215,000
Value of certain deemed distributions of participant loans2013-06-30$0
Value of corrective distributions2013-06-30$0
Funding deficiency by the employer to the plan for this plan year2013-06-30$0
Minimum employer required contribution for this plan year2013-06-30$0
Amount contributed by the employer to the plan for this plan year2013-06-30$0
2012 : PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2012 401k financial data
Transfers to/from the plan2012-06-30$0
Total income from all sources2012-06-30$135,384
Expenses. Total of all expenses incurred2012-06-30$429
Benefits paid (including direct rollovers)2012-06-30$0
Total plan assets at end of year2012-06-30$738,058
Total plan assets at beginning of year2012-06-30$603,103
Value of fidelity bond covering the plan2012-06-30$100,000
Total contributions received or receivable from participants2012-06-30$57,843
Expenses. Other expenses not covered elsewhere2012-06-30$429
Contributions received from other sources (not participants or employers)2012-06-30$0
Other income received2012-06-30$2,541
Net income (gross income less expenses)2012-06-30$134,955
Net plan assets at end of year (total assets less liabilities)2012-06-30$738,058
Net plan assets at beginning of year (total assets less liabilities)2012-06-30$603,103
Assets. Value of participant loans2012-06-30$1,076
Total contributions received or receivable from employer(s)2012-06-30$75,000
Value of certain deemed distributions of participant loans2012-06-30$0
Value of corrective distributions2012-06-30$0
2011 : PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan2011-06-30$0
Total income from all sources2011-06-30$134,916
Expenses. Total of all expenses incurred2011-06-30$67,611
Benefits paid (including direct rollovers)2011-06-30$66,970
Total plan assets at end of year2011-06-30$603,103
Total plan assets at beginning of year2011-06-30$535,798
Value of fidelity bond covering the plan2011-06-30$100,000
Total contributions received or receivable from participants2011-06-30$48,760
Expenses. Other expenses not covered elsewhere2011-06-30$641
Contributions received from other sources (not participants or employers)2011-06-30$0
Other income received2011-06-30$86,156
Net income (gross income less expenses)2011-06-30$67,305
Net plan assets at end of year (total assets less liabilities)2011-06-30$603,103
Net plan assets at beginning of year (total assets less liabilities)2011-06-30$535,798
Assets. Value of participant loans2011-06-30$4,300
Total contributions received or receivable from employer(s)2011-06-30$0
Value of certain deemed distributions of participant loans2011-06-30$0
Value of corrective distributions2011-06-30$0
Funding deficiency by the employer to the plan for this plan year2011-06-30$0
Minimum employer required contribution for this plan year2011-06-30$0
Amount contributed by the employer to the plan for this plan year2011-06-30$0
2010 : PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan2010-06-30$0
Total income from all sources2010-06-30$84,821
Expenses. Total of all expenses incurred2010-06-30$3,662
Benefits paid (including direct rollovers)2010-06-30$2,846
Total plan assets at end of year2010-06-30$535,798
Total plan assets at beginning of year2010-06-30$454,639
Total contributions received or receivable from participants2010-06-30$44,439
Expenses. Other expenses not covered elsewhere2010-06-30$816
Contributions received from other sources (not participants or employers)2010-06-30$0
Other income received2010-06-30$40,382
Net income (gross income less expenses)2010-06-30$81,159
Net plan assets at end of year (total assets less liabilities)2010-06-30$535,798
Net plan assets at beginning of year (total assets less liabilities)2010-06-30$454,639
Assets. Value of participant loans2010-06-30$4,300
Total contributions received or receivable from employer(s)2010-06-30$0
Value of certain deemed distributions of participant loans2010-06-30$0
Value of corrective distributions2010-06-30$0
Funding deficiency by the employer to the plan for this plan year2010-06-30$0
Minimum employer required contribution for this plan year2010-06-30$0
Amount contributed by the employer to the plan for this plan year2010-06-30$0

Form 5500 Responses for PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN

2014: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2009: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes
2006: PATRICK ENTERPRISES 401(K) PROFIT SHARING PLAN 2006 form 5500 responses
2006-07-01Type of plan entitySingle employer plan
2006-07-01Submission has been amendedNo
2006-07-01This submission is the final filingNo
2006-07-01This return/report is a short plan year return/report (less than 12 months)No
2006-07-01Plan is a collectively bargained planNo
2006-07-01Plan funding arrangement – InsuranceYes
2006-07-01Plan funding arrangement – TrustYes
2006-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-802327
Policy instance 1
Insurance contract or identification numberGA-802327
Number of Individuals Covered28
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $5,023
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 $5,023
Insurance broker organization code?3
Insurance broker nameINFINEX INVESTMENTS INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-802327
Policy instance 1
Insurance contract or identification numberGA-802327
Number of Individuals Covered37
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $4,587
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 $4,587
Insurance broker organization code?3
Insurance broker nameINFINEX INVESTMENTS INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-802327
Policy instance 1
Insurance contract or identification numberGA-802327
Number of Individuals Covered22
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $3,556
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 $3,556
Insurance broker organization code?3
Insurance broker nameINFINEX INVESTMENTS INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-802327
Policy instance 1
Insurance contract or identification numberGA-802327
Number of Individuals Covered31
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,608
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-802327
Policy instance 1
Insurance contract or identification numberGA-802327
Number of Individuals Covered27
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $2,280
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

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