401k Plan data: HOTCHKISS INSURANCE AGENCY 401(K) PLAN plan

HOTCHKISS INSURANCE AGENCY 401(K) PLAN 401k Plan overview

Plan Name	HOTCHKISS INSURANCE AGENCY 401(K) PLAN
Plan identification number	001

HOTCHKISS INSURANCE AGENCY 401(K) PLAN Benefits

401k Plan Type

Defined 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.
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.
Plan covering Self-Employed individuals.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

HOTCHKISS INSURANCE AGENCY LLC has sponsored the creation of one or more 401k plans.

Company Name: HOTCHKISS INSURANCE AGENCY LLC

Employer identification number (EIN): 900341291

NAIC Classification: 524210
NAIC Description: Insurance Agencies and Brokerages

Additional information about HOTCHKISS INSURANCE AGENCY LLC

Jurisdiction of Incorporation: Georgia Department of States Corporations Division

Incorporation Date:

Company Identification Number: 1436068

More information about HOTCHKISS INSURANCE AGENCY LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOTCHKISS INSURANCE AGENCY 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2018-01-01
001 2018-01-01
001 2017-01-01 HEATHER ETHEREDGE 2018-07-25 HEATHER ETHEREDGE 2018-07-25
001 2016-01-01 HEATHER ETHEREDGE 2017-07-19 HEATHER ETHEREDGE 2017-07-19
001 2015-01-01 HEATHER ETHEREDGE 2016-07-19 HEATHER ETHEREDGE 2016-07-19
001 2014-01-01 HEATHER ETHEREDGE 2015-07-21 HEATHER ETHEREDGE 2015-07-21
001 2013-01-01 HEATHER ETHEREDGE 2014-07-23 HEATHER ETHEREDGE 2014-07-23
001 2012-01-01 BRANDEE FREEMAN 2013-10-11
001 2011-01-01 BRANDEE FREEMAN
001 2009-01-01 BRANDEE FREEMAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2018-01-01
001	2018-01-01
001	2017-01-01	HEATHER ETHEREDGE	2018-07-25	HEATHER ETHEREDGE	2018-07-25
001	2016-01-01	HEATHER ETHEREDGE	2017-07-19	HEATHER ETHEREDGE	2017-07-19
001	2015-01-01	HEATHER ETHEREDGE	2016-07-19	HEATHER ETHEREDGE	2016-07-19
001	2014-01-01	HEATHER ETHEREDGE	2015-07-21	HEATHER ETHEREDGE	2015-07-21
001	2013-01-01	HEATHER ETHEREDGE	2014-07-23	HEATHER ETHEREDGE	2014-07-23
001	2012-01-01	BRANDEE FREEMAN	2013-10-11
001	2011-01-01	BRANDEE FREEMAN
001	2009-01-01	BRANDEE FREEMAN

Plan Statistics for HOTCHKISS INSURANCE AGENCY 401(K) PLAN

401k plan membership statisitcs for HOTCHKISS INSURANCE AGENCY 401(K) PLAN

Measure Date Value
2018: HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 125
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 108
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 16
Total of all active and inactive participants 2018-01-01 124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-01-01 0
Total participants 2018-01-01 124
Number of participants with account balances 2018-01-01 120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-01-01 10
2011: HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 100
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 79
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 17
Total of all active and inactive participants 2011-01-01 96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 96
Number of participants with account balances 2011-01-01 86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 2
2009: HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 128
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 137
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 13
Total of all active and inactive participants 2009-01-01 150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 150
Number of participants with account balances 2009-01-01 100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 24

Measure	Date	Value
2018: HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	125
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	108
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	16
Total of all active and inactive participants	2018-01-01	124
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	124
Number of participants with account balances	2018-01-01	120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	10
2011: HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	100
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	79
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	17
Total of all active and inactive participants	2011-01-01	96
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	96
Number of participants with account balances	2011-01-01	86
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	2
2009: HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	128
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	137
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	13
Total of all active and inactive participants	2009-01-01	150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	150
Number of participants with account balances	2009-01-01	100
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	24

Financial Data on HOTCHKISS INSURANCE AGENCY 401(K) PLAN

Measure	Date	Value
2018 : HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$627,652
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$298,917
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$241,334
Expenses. Certain deemed distributions of participant loans	2018-12-31	$0
Value of total corrective distributions	2018-12-31	$364
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,201,885
Value of total assets at end of year	2018-12-31	$9,509,923
Value of total assets at beginning of year	2018-12-31	$9,181,188
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$57,219
Total interest from all sources	2018-12-31	$44,344
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$580,323
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$580,323
Administrative expenses professional fees incurred	2018-12-31	$0
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$753,228
Participant contributions at end of year	2018-12-31	$183,564
Participant contributions at beginning of year	2018-12-31	$135,222
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$270,281
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2018-12-31	$0
Other income not declared elsewhere	2018-12-31	$0
Administrative expenses (other) incurred	2018-12-31	$265
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$328,735
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$9,509,923
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$9,181,188
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Investment advisory and management fees	2018-12-31	$54,781
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$8,012,685
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$7,757,857
Value of interest in pooled separate accounts at end of year	2018-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$0
Interest on participant loans	2018-12-31	$14,078
Interest earned on other investments	2018-12-31	$30,266
Value of interest in common/collective trusts at end of year	2018-12-31	$0
Value of interest in common/collective trusts at beginning of year	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$1,313,674
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$1,288,109
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-1,198,900
Net investment gain/loss from pooled separate accounts	2018-12-31	$0
Net investment gain or loss from common/collective trusts	2018-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Assets. Invements in employer securities at end of year	2018-12-31	$0
Assets. Invements in employer securities at beginning of year	2018-12-31	$0
Contributions received in cash from employer	2018-12-31	$178,376
Income. Dividends from common stock	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$241,334
Contract administrator fees	2018-12-31	$2,173
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	GOLDIN PEISER & PEISESR, LLP
Accountancy firm EIN	2018-12-31	752515294
2011 : HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$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	$341,507
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$300,418
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$296,543
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$372,419
Value of total assets at end of year	2011-12-31	$4,049,611
Value of total assets at beginning of year	2011-12-31	$4,008,522
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$3,875
Total interest from all sources	2011-12-31	$10,556
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 year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$450,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$354,403
Participant contributions at end of year	2011-12-31	$131,272
Participant contributions at beginning of year	2011-12-31	$156,049
Participant contributions at end of year	2011-12-31	$9,131
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$18,016
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$2,530
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$41,089
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$4,049,611
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$4,008,522
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$3,906,678
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$3,852,473
Interest on participant loans	2011-12-31	$10,556
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$0
Net investment gain/loss from pooled separate accounts	2011-12-31	$-41,468
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$296,543
Contract administrator fees	2011-12-31	$3,875
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	GOLDIN PEISER & PEISER LLP
Accountancy firm EIN	2011-12-31	752515294
2010 : HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2010 401k financial data
Total income from all sources (including contributions)	2010-12-31	$838,919
Total of all expenses incurred	2010-12-31	$457,607
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$453,582
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$416,175
Value of total assets at end of year	2010-12-31	$4,008,522
Value of total assets at beginning of year	2010-12-31	$3,627,210
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$4,025
Total interest from all sources	2010-12-31	$12,738
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$2,630
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$450,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$369,373
Participant contributions at end of year	2010-12-31	$156,049
Participant contributions at beginning of year	2010-12-31	$148,615
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$46,802
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$381,312
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$4,008,522
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$3,627,210
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$3,852,473
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$3,478,595
Interest on participant loans	2010-12-31	$12,738
Net investment gain/loss from pooled separate accounts	2010-12-31	$410,006
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$453,582
Contract administrator fees	2010-12-31	$1,395
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	BADER & ASSOCIATES, P.C.
Accountancy firm EIN	2010-12-31	752295408
2009 : HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for HOTCHKISS INSURANCE AGENCY 401(K) PLAN

2018: HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2011: HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: HOTCHKISS INSURANCE AGENCY 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )

Policy contract number

MR 60968

Policy instance

Insurance contract or identification number	MR 60968
Number of Individuals Covered	124
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

812957

Policy instance

Insurance contract or identification number	812957
Number of Individuals Covered	86
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,535
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

812957

Policy instance

Insurance contract or identification number	812957
Number of Individuals Covered	100
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,715
Total amount of fees paid to insurance company	USD $0
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

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Company Name:	HOTCHKISS INSURANCE AGENCY LLC
Employer identification number (EIN):	900341291
NAIC Classification:	524210
NAIC Description:	Insurance Agencies and Brokerages

Jurisdiction of Incorporation:	Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number:	1436068