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OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan NameOKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST
Plan identification number 001

OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • 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

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

Company Name:OKLAHOMA STATE BANK
Employer identification number (EIN):730384150
NAIC Classification:522110
NAIC Description:Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01ROBERT BANKS2023-07-26
0012021-01-01JIM CANTON2022-07-28
0012020-01-01BRENDA MULL2021-05-27
0012019-01-01BRENDA MULL2020-03-13
0012018-01-01BRENDA MULL2019-02-04
0012017-01-01BRENDA MULL
0012016-01-01BRENDA MULL
0012015-01-01BRENDA MULL
0012014-01-01BRENDA MULL
0012013-01-01BRENDA MULL
0012012-01-01BRENDA MULL
0012011-01-01ROGER KEEL KEITH VENTRIS2012-07-18
0012009-01-01KEITH VENTRIS
0012009-01-01KEITH VENTRIS ROGER KEEL2010-07-16
0012009-01-01 KEITH VENTRIS2010-07-09

Plan Statistics for OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST

Measure Date Value
2017: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2017 401k membership
Total participants, beginning-of-year2017-01-0137
Total number of active participants reported on line 7a of the Form 55002017-01-0129
Number of retired or separated participants receiving benefits2017-01-014
Number of other retired or separated participants entitled to future benefits2017-01-015
Total of all active and inactive participants2017-01-0138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0138
Number of participants with account balances2017-01-0137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2016 401k membership
Total participants, beginning-of-year2016-01-0138
Total number of active participants reported on line 7a of the Form 55002016-01-0133
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-015
Total of all active and inactive participants2016-01-0138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0138
Number of participants with account balances2016-01-0134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-0133
Total number of active participants reported on line 7a of the Form 55002015-01-0133
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-015
Total of all active and inactive participants2015-01-0138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0138
Number of participants with account balances2015-01-0133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-011
2014: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-0131
Total number of active participants reported on line 7a of the Form 55002014-01-0122
Number of other retired or separated participants entitled to future benefits2014-01-0111
Total of all active and inactive participants2014-01-0133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0133
Number of participants with account balances2014-01-0128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-0127
Total number of active participants reported on line 7a of the Form 55002013-01-0129
Number of other retired or separated participants entitled to future benefits2013-01-016
Total of all active and inactive participants2013-01-0135
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0135
Number of participants with account balances2013-01-0130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-0121
Total number of active participants reported on line 7a of the Form 55002012-01-0124
Number of retired or separated participants receiving benefits2012-01-012
Number of other retired or separated participants entitled to future benefits2012-01-011
Total of all active and inactive participants2012-01-0127
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0127
Number of participants with account balances2012-01-0126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-011
2011: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-0124
Total number of active participants reported on line 7a of the Form 55002011-01-0121
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-013
Total of all active and inactive participants2011-01-0124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0124
Number of participants with account balances2011-01-0124
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-0124
Total number of active participants reported on line 7a of the Form 55002009-01-0123
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-013
Total of all active and inactive participants2009-01-0126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0126
Number of participants with account balances2009-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-012

Financial Data on OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST

Measure Date Value
2017 : OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2017 401k financial data
Total income from all sources2017-12-31$326,918
Expenses. Total of all expenses incurred2017-12-31$36,576
Benefits paid (including direct rollovers)2017-12-31$36,576
Total plan assets at end of year2017-12-31$1,104,713
Total plan assets at beginning of year2017-12-31$814,371
Value of fidelity bond covering the plan2017-12-31$1,825,000
Total contributions received or receivable from participants2017-12-31$115,849
Contributions received from other sources (not participants or employers)2017-12-31$12,372
Other income received2017-12-31$126,949
Net income (gross income less expenses)2017-12-31$290,342
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,104,713
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$814,371
Total contributions received or receivable from employer(s)2017-12-31$71,748
Value of certain deemed distributions of participant loans2017-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$0
2016 : OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2016 401k financial data
Total income from all sources2016-12-31$259,782
Expenses. Total of all expenses incurred2016-12-31$102,516
Benefits paid (including direct rollovers)2016-12-31$102,516
Total plan assets at end of year2016-12-31$814,371
Total plan assets at beginning of year2016-12-31$657,105
Value of fidelity bond covering the plan2016-12-31$1,825,000
Total contributions received or receivable from participants2016-12-31$116,960
Contributions received from other sources (not participants or employers)2016-12-31$35,983
Other income received2016-12-31$35,663
Net income (gross income less expenses)2016-12-31$157,266
Net plan assets at end of year (total assets less liabilities)2016-12-31$814,371
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$657,105
Total contributions received or receivable from employer(s)2016-12-31$71,176
Value of certain deemed distributions of participant loans2016-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$0
2015 : OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2015 401k financial data
Total income from all sources2015-12-31$123,793
Expenses. Total of all expenses incurred2015-12-31$85,892
Benefits paid (including direct rollovers)2015-12-31$85,892
Total plan assets at end of year2015-12-31$657,105
Total plan assets at beginning of year2015-12-31$619,204
Value of fidelity bond covering the plan2015-12-31$1,825,000
Total contributions received or receivable from participants2015-12-31$100,979
Contributions received from other sources (not participants or employers)2015-12-31$0
Other income received2015-12-31$-37,541
Net income (gross income less expenses)2015-12-31$37,901
Net plan assets at end of year (total assets less liabilities)2015-12-31$657,105
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$619,204
Total contributions received or receivable from employer(s)2015-12-31$60,355
Value of certain deemed distributions of participant loans2015-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$0
2014 : OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2014 401k financial data
Total income from all sources2014-12-31$168,921
Expenses. Total of all expenses incurred2014-12-31$149,290
Benefits paid (including direct rollovers)2014-12-31$149,290
Total plan assets at end of year2014-12-31$619,204
Total plan assets at beginning of year2014-12-31$599,573
Value of fidelity bond covering the plan2014-12-31$1,825,000
Total contributions received or receivable from participants2014-12-31$83,182
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$34,226
Net income (gross income less expenses)2014-12-31$19,631
Net plan assets at end of year (total assets less liabilities)2014-12-31$619,204
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$599,573
Total contributions received or receivable from employer(s)2014-12-31$51,513
Value of certain deemed distributions of participant loans2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$0
2013 : OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2013 401k financial data
Total income from all sources2013-12-31$248,564
Expenses. Total of all expenses incurred2013-12-31$187,679
Benefits paid (including direct rollovers)2013-12-31$187,679
Total plan assets at end of year2013-12-31$599,573
Total plan assets at beginning of year2013-12-31$538,688
Value of fidelity bond covering the plan2013-12-31$1,828,000
Total contributions received or receivable from participants2013-12-31$76,000
Contributions received from other sources (not participants or employers)2013-12-31$30,801
Other income received2013-12-31$97,246
Net income (gross income less expenses)2013-12-31$60,885
Net plan assets at end of year (total assets less liabilities)2013-12-31$599,573
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$538,688
Total contributions received or receivable from employer(s)2013-12-31$44,517
Value of certain deemed distributions of participant loans2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$0
2012 : OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2012 401k financial data
Transfers to/from the plan2012-12-31$-2
Total income from all sources2012-12-31$164,011
Expenses. Total of all expenses incurred2012-12-31$21,363
Benefits paid (including direct rollovers)2012-12-31$21,363
Total plan assets at end of year2012-12-31$538,688
Total plan assets at beginning of year2012-12-31$396,042
Value of fidelity bond covering the plan2012-12-31$1,825,000
Total contributions received or receivable from participants2012-12-31$77,244
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$4,893
Other income received2012-12-31$44,354
Net income (gross income less expenses)2012-12-31$142,648
Net plan assets at end of year (total assets less liabilities)2012-12-31$538,688
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$396,042
Assets. Value of participant loans2012-12-31$0
Total contributions received or receivable from employer(s)2012-12-31$37,520
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
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 : OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total income from all sources2011-12-31$61,364
Expenses. Total of all expenses incurred2011-12-31$18,163
Benefits paid (including direct rollovers)2011-12-31$18,163
Total plan assets at end of year2011-12-31$396,042
Total plan assets at beginning of year2011-12-31$352,841
Value of fidelity bond covering the plan2011-12-31$1,825,000
Total contributions received or receivable from participants2011-12-31$43,272
Expenses. Other expenses not covered elsewhere2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-8,910
Net income (gross income less expenses)2011-12-31$43,201
Net plan assets at end of year (total assets less liabilities)2011-12-31$396,042
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$352,841
Assets. Value of participant loans2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$27,002
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 : OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total income from all sources2010-12-31$90,797
Expenses. Total of all expenses incurred2010-12-31$2,911
Benefits paid (including direct rollovers)2010-12-31$2,911
Total plan assets at end of year2010-12-31$352,841
Total plan assets at beginning of year2010-12-31$264,955
Value of fidelity bond covering the plan2010-12-31$1,825,000
Total contributions received or receivable from participants2010-12-31$34,935
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$28,287
Net income (gross income less expenses)2010-12-31$87,886
Net plan assets at end of year (total assets less liabilities)2010-12-31$352,841
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$264,955
Assets. Value of participant loans2010-12-31$0
Total contributions received or receivable from employer(s)2010-12-31$27,575
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 : OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 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 OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST

2017: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedYes
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: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 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
2009: OKLAHOMA STATE BANK PROFIT SHARING PLAN AND TRUST 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
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

NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number871-80573
Policy instance 1
Insurance contract or identification number871-80573
Number of Individuals Covered29
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameROYAL ALLIANCE ASSOC, INC.
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number
Policy instance 1
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Insurance broker organization code?3
Insurance broker nameROYAL ALLIANCE ASSOC, INC.
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number
Policy instance 1
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Insurance broker organization code?3
Insurance broker nameFIRST INDEPENDENT FINANCIAL
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number
Policy instance 1
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Insurance broker organization code?3
Insurance broker nameFIRST INDEPENDENT FINANCIAL
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 )
Policy contract number
Policy instance 2
Are there contracts with unallocated funds for contracts of type guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameFIRST INDEPENDENT FINANCIAL
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA025771
Policy instance 1
Insurance contract or identification numberGA025771
Number of Individuals Covered0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
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-025771
Policy instance 1
Insurance contract or identification numberGA-025771
Number of Individuals Covered26
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,263
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 $2,263
Insurance broker organization code?3
Insurance broker nameEDWARD D JONES & CO
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-025771
Policy instance 1
Insurance contract or identification numberGA-025771
Number of Individuals Covered24
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,826
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-025771
Policy instance 1
Insurance contract or identification numberGA-025771
Number of Individuals Covered23
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,415
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 $1,415
Insurance broker organization code?3
Insurance broker nameEDWARD D JONES & CO

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