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HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 401k Plan overview

Plan NameHEALTH CARE UNLIMITED/NISKERS 401(K) PLAN
Plan identification number 001

HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 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.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

HEALTH CARE UNLIMITED, INC. has sponsored the creation of one or more 401k plans.

Company Name:HEALTH CARE UNLIMITED, INC.
Employer identification number (EIN):742583556
NAIC Classification:621610
NAIC Description:Home Health Care Services

Additional information about HEALTH CARE UNLIMITED, INC.

Jurisdiction of Incorporation: Florida Department of State Division of Corporations
Incorporation Date: 1992-11-16
Company Identification Number: P92000006122
Legal Registered Office Address: 15439 SW 80 STREET

MIAMI

33193

More information about HEALTH CARE UNLIMITED, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012012-01-01JOSEPH RAMON2012-10-04
0012011-01-01JOSEPH RAMON
0012009-01-01JOSEPH RAMON, III
0012009-01-01JOSEPH RAMON, III
0012008-01-01JOSEPH RAMON III
0012007-01-01 JOSEPH RAMON III2010-08-12
0012007-01-01 JOSEPH RAMON III2010-03-25
0012006-01-01JOSEPH RAMON III
0012005-01-01JOSEPH RAMON III

Plan Statistics for HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN

401k plan membership statisitcs for HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN

Measure Date Value
2011: HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01917
Total number of active participants reported on line 7a of the Form 55002011-01-01827
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0137
Total of all active and inactive participants2011-01-01864
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01864
Number of participants with account balances2011-01-0171
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-012
2009: HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01767
Total number of active participants reported on line 7a of the Form 55002009-01-01776
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-01108
Total of all active and inactive participants2009-01-01884
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01884
Number of participants with account balances2009-01-01166
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-016
2008: HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01659
Total number of active participants reported on line 7a of the Form 55002008-01-01659
Number of retired or separated participants receiving benefits2008-01-010
Number of other retired or separated participants entitled to future benefits2008-01-01108
Total of all active and inactive participants2008-01-01767
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2008-01-010
Total participants2008-01-01767
Number of participants with account balances2008-01-01168
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2008-01-016
2007: HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01654
Total number of active participants reported on line 7a of the Form 55002007-01-01580
Number of retired or separated participants receiving benefits2007-01-010
Number of other retired or separated participants entitled to future benefits2007-01-0173
Total of all active and inactive participants2007-01-01653
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2007-01-010
Total participants2007-01-01653
Number of participants with account balances2007-01-01179
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2007-01-018
2006: HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2006 401k membership
Total participants, beginning-of-year2006-01-01721
Total number of active participants reported on line 7a of the Form 55002006-01-01615
Number of other retired or separated participants entitled to future benefits2006-01-0162
Total of all active and inactive participants2006-01-01677
Total participants2006-01-01677
Number of participants with account balances2006-01-01130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2006-01-016
2005: HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2005 401k membership
Total participants, beginning-of-year2005-01-01282
Total number of active participants reported on line 7a of the Form 55002005-01-01662
Number of other retired or separated participants entitled to future benefits2005-01-0159
Total of all active and inactive participants2005-01-01721
Total participants2005-01-01721
Number of participants with account balances2005-01-01126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2005-01-0111

Financial Data on HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN

Measure Date Value
2011 : HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$37,435
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$370,394
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$368,021
Value of total corrective distributions2011-12-31$20
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$48,030
Value of total assets at end of year2011-12-31$208,099
Value of total assets at beginning of year2011-12-31$541,058
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$2,353
Total interest from all sources2011-12-31$1,410
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2011-12-31$0
Assets. Real estate other than employer real property at beginning of year2011-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2011-12-31$0
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$100,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$48,030
Participant contributions at end of year2011-12-31$17,198
Participant contributions at beginning of year2011-12-31$14,450
Participant contributions at beginning of year2011-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$0
Assets. Loans (other than to participants) at beginning of year2011-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$0
Other income not declared elsewhere2011-12-31$-125
Administrative expenses (other) incurred2011-12-31$2,353
Liabilities. Value of operating payables at beginning of year2011-12-31$0
Total non interest bearing cash at beginning of year2011-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-332,959
Value of net assets at end of year (total assets less liabilities)2011-12-31$208,099
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$541,058
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Assets. partnership/joint venture interests at beginning of year2011-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$0
Value of interest in pooled separate accounts at end of year2011-12-31$190,901
Value of interest in pooled separate accounts at beginning of year2011-12-31$526,608
Interest on participant loans2011-12-31$1,410
Value of interest in master investment trust accounts at beginning of year2011-12-31$0
Value of interest in common/collective trusts at beginning of year2011-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2011-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$0
Asset value of US Government securities at beginning of year2011-12-31$0
Net investment gain/loss from pooled separate accounts2011-12-31$-11,880
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Assets. Invements in employer securities at beginning of year2011-12-31$0
Assets. Value of employer real property at beginning of year2011-12-31$0
Employer contributions (assets) at beginning of year2011-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$368,021
Asset. Corporate debt instrument preferred debt at beginning of year2011-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2011-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2011-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2011-12-31$0
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Liabilities. Value of acquisition indebtedness at beginning of year2011-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31SALINAS, ALLEN & SCHMITT, LLP
Accountancy firm EIN2011-12-31742517388
2010 : HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$111,173
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$254,695
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$249,855
Value of total corrective distributions2010-12-31$722
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$72,610
Value of total assets at end of year2010-12-31$541,058
Value of total assets at beginning of year2010-12-31$684,580
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$4,118
Total interest from all sources2010-12-31$1,570
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Assets. Real estate other than employer real property at end of year2010-12-31$0
Assets. Real estate other than employer real property at beginning of year2010-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2010-12-31$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2010-12-31$0
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$100,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$72,610
Participant contributions at end of year2010-12-31$14,450
Participant contributions at beginning of year2010-12-31$20,120
Participant contributions at end of year2010-12-31$0
Participant contributions at beginning of year2010-12-31$0
Assets. Other investments not covered elsewhere at end of year2010-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$0
Assets. Loans (other than to participants) at end of year2010-12-31$0
Assets. Loans (other than to participants) at beginning of year2010-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$0
Other income not declared elsewhere2010-12-31$7
Administrative expenses (other) incurred2010-12-31$4,118
Liabilities. Value of operating payables at end of year2010-12-31$0
Liabilities. Value of operating payables at beginning of year2010-12-31$0
Total non interest bearing cash at end of year2010-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-143,522
Value of net assets at end of year (total assets less liabilities)2010-12-31$541,058
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$684,580
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Assets. partnership/joint venture interests at end of year2010-12-31$0
Assets. partnership/joint venture interests at beginning of year2010-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$0
Value of interest in pooled separate accounts at end of year2010-12-31$526,608
Value of interest in pooled separate accounts at beginning of year2010-12-31$664,460
Interest on participant loans2010-12-31$1,570
Value of interest in master investment trust accounts at end of year2010-12-31$0
Value of interest in master investment trust accounts at beginning of year2010-12-31$0
Value of interest in common/collective trusts at end of year2010-12-31$0
Value of interest in common/collective trusts at beginning of year2010-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$0
Assets. Value of investments in 103.12 investment entities at end of year2010-12-31$0
Assets. Value of investments in 103.12 investment entities at beginning of year2010-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$0
Asset value of US Government securities at end of year2010-12-31$0
Asset value of US Government securities at beginning of year2010-12-31$0
Net investment gain/loss from pooled separate accounts2010-12-31$36,986
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31Yes
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Assets. Invements in employer securities at end of year2010-12-31$0
Assets. Invements in employer securities at beginning of year2010-12-31$0
Assets. Value of employer real property at end of year2010-12-31$0
Assets. Value of employer real property at beginning of year2010-12-31$0
Employer contributions (assets) at end of year2010-12-31$0
Employer contributions (assets) at beginning of year2010-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$249,855
Asset. Corporate debt instrument preferred debt at end of year2010-12-31$0
Asset. Corporate debt instrument preferred debt at beginning of year2010-12-31$0
Asset. Corporate debt instrument debt (other) at end of year2010-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2010-12-31$0
Assets. Corporate common stocks other than exployer securities at end of year2010-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2010-12-31$0
Liabilities. Value of benefit claims payable at end of year2010-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$0
Assets. Value of buildings and other operty used in plan operation at end of year2010-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2010-12-31$0
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Liabilities. Value of acquisition indebtedness at end of year2010-12-31$0
Liabilities. Value of acquisition indebtedness at beginning of year2010-12-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31SALINAS, ALLEN & SCHMITT, LLP
Accountancy firm EIN2010-12-31742517388

Form 5500 Responses for HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN

2011: HEALTH CARE UNLIMITED/NISKERS 401(K) 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
2011-01-01Plan benefit arrangement - TrustYes
2009: HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 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
2009-01-01Plan benefit arrangement - TrustYes
2008: HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Submission has been amendedYes
2008-01-01This submission is the final filingNo
2008-01-01This return/report is a short plan year return/report (less than 12 months)No
2008-01-01Plan is a collectively bargained planNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan funding arrangement – TrustYes
2008-01-01Plan benefit arrangement – InsuranceYes
2008-01-01Plan benefit arrangement - TrustYes
2007: HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Submission has been amendedYes
2007-01-01This submission is the final filingNo
2007-01-01This return/report is a short plan year return/report (less than 12 months)No
2007-01-01Plan is a collectively bargained planNo
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan funding arrangement – TrustYes
2007-01-01Plan benefit arrangement – InsuranceYes
2007-01-01Plan benefit arrangement - TrustYes
2006: HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2006 form 5500 responses
2006-01-01Type of plan entitySingle employer plan
2006-01-01Submission has been amendedYes
2006-01-01This submission is the final filingNo
2006-01-01This return/report is a short plan year return/report (less than 12 months)No
2006-01-01Plan is a collectively bargained planNo
2006-01-01Plan funding arrangement – TrustYes
2006-01-01Plan benefit arrangement - TrustYes
2005: HEALTH CARE UNLIMITED/NISKERS 401(K) PLAN 2005 form 5500 responses
2005-01-01Type of plan entitySingle employer plan
2005-01-01Submission has been amendedYes
2005-01-01This submission is the final filingNo
2005-01-01This return/report is a short plan year return/report (less than 12 months)No
2005-01-01Plan is a collectively bargained planNo
2005-01-01Plan funding arrangement – TrustYes
2005-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number803922
Policy instance 1
Insurance contract or identification number803922
Number of Individuals Covered71
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,724
Total amount of fees paid to insurance companyUSD $263
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
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
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number803922
Policy instance 1
Insurance contract or identification number803922
Number of Individuals Covered60
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,090
Total amount of fees paid to insurance companyUSD $325
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
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
Commission paid to Insurance BrokerUSD $2,090
Insurance broker organization code?3
Amount paid for insurance broker fees325
Additional information about fees paid to insurance brokerSALES/ADMINISTRATION
Insurance broker nameLOREN D. STARK COMPANY, INC.

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