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EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan NameEMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST
Plan identification number 001

EMPIRE OPTICAL, INC. 401(K) 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.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • 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

EMPIRE OPTICAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:EMPIRE OPTICAL, INC.
Employer identification number (EIN):731047228
NAIC Classification:446130
NAIC Description:Optical Goods Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01
0012022-01-01
0012021-01-01
0012020-01-01CHRISTIAN HARGROVE2021-05-18 CHRISTIAN HARGROVE2021-05-18
0012019-01-01CHRISTIAN HARGROVE2020-09-22 CHRISTIAN HARGROVE2020-09-22
0012018-01-01CHRISTIAN HARGROVE2019-07-08 CHRISTIAN HARGROVE2019-07-08
0012017-01-01CHRISTIAN HARGROVE2018-06-14
0012016-01-01CHRISTIAN HARGROVE2017-06-21
0012015-01-01CHRISTIAN HARGROVE2016-06-13 CHRISTIAN HARGROVE2016-06-13
0012014-01-01CHRISTIAN HARGROVE
0012013-01-01CHRISTIAN HARGROVE
0012012-01-01CHRISTIAN HARGROVE
0012011-01-01CHRISTIAN HARGROVE
0012010-01-01CHRISTIAN HARGROVE
0012009-01-01CHRISTIAN HARGROVE

Plan Statistics for EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2014: EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-0116
Total number of active participants reported on line 7a of the Form 55002014-01-0115
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-012
Total of all active and inactive participants2014-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0117
Number of participants with account balances2014-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-0116
Total number of active participants reported on line 7a of the Form 55002013-01-0113
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-013
Total of all active and inactive participants2013-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0116
Number of participants with account balances2013-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-0116
Total number of active participants reported on line 7a of the Form 55002012-01-0114
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-012
Total of all active and inactive participants2012-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0116
Number of participants with account balances2012-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-011
2011: EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-0119
Total number of active participants reported on line 7a of the Form 55002011-01-0114
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-012
Total of all active and inactive participants2011-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0116
Number of participants with account balances2011-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year2010-01-0119
Total number of active participants reported on line 7a of the Form 55002010-01-0117
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0117
Number of participants with account balances2010-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2009 401k membership
Total participants, beginning-of-year2009-01-0118
Total number of active participants reported on line 7a of the Form 55002009-01-0117
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-011
Total of all active and inactive participants2009-01-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0118
Number of participants with account balances2009-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2014 : EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total income from all sources2014-12-31$141,846
Expenses. Total of all expenses incurred2014-12-31$32,853
Benefits paid (including direct rollovers)2014-12-31$32,741
Total plan assets at end of year2014-12-31$1,525,948
Total plan assets at beginning of year2014-12-31$1,416,955
Value of fidelity bond covering the plan2014-12-31$150,000
Total contributions received or receivable from participants2014-12-31$38,421
Expenses. Other expenses not covered elsewhere2014-12-31$112
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$75,071
Net income (gross income less expenses)2014-12-31$108,993
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,525,948
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,416,955
Assets. Value of participant loans2014-12-31$25,000
Total contributions received or receivable from employer(s)2014-12-31$28,354
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
Funding deficiency by the employer to the plan for this plan year2014-12-31$0
Minimum employer required contribution for this plan year2014-12-31$0
Amount contributed by the employer to the plan for this plan year2014-12-31$0
2013 : EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2013 401k financial data
Transfers to/from the plan2013-12-31$5
Total income from all sources2013-12-31$285,303
Expenses. Total of all expenses incurred2013-12-31$231,973
Benefits paid (including direct rollovers)2013-12-31$231,932
Total plan assets at end of year2013-12-31$1,416,955
Total plan assets at beginning of year2013-12-31$1,363,620
Value of fidelity bond covering the plan2013-12-31$75,000
Total contributions received or receivable from participants2013-12-31$40,562
Expenses. Other expenses not covered elsewhere2013-12-31$41
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$215,496
Net income (gross income less expenses)2013-12-31$53,330
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,416,955
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,363,620
Assets. Value of participant loans2013-12-31$3,613
Total contributions received or receivable from employer(s)2013-12-31$29,245
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Funding deficiency by the employer to the plan for this plan year2013-12-31$0
Minimum employer required contribution for this plan year2013-12-31$0
Amount contributed by the employer to the plan for this plan year2013-12-31$0
2012 : EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2012 401k financial data
Transfers to/from the plan2012-12-31$17
Total income from all sources2012-12-31$257,364
Expenses. Total of all expenses incurred2012-12-31$184,462
Benefits paid (including direct rollovers)2012-12-31$184,346
Total plan assets at end of year2012-12-31$1,363,620
Total plan assets at beginning of year2012-12-31$1,290,701
Value of fidelity bond covering the plan2012-12-31$75,000
Total contributions received or receivable from participants2012-12-31$54,750
Expenses. Other expenses not covered elsewhere2012-12-31$116
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$172,498
Net income (gross income less expenses)2012-12-31$72,902
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,363,620
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,290,701
Assets. Value of participant loans2012-12-31$7,957
Total contributions received or receivable from employer(s)2012-12-31$30,116
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 : EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2011 401k financial data
Transfers to/from the plan2011-12-31$4
Total income from all sources2011-12-31$24,639
Expenses. Total of all expenses incurred2011-12-31$74,445
Benefits paid (including direct rollovers)2011-12-31$74,379
Total plan assets at end of year2011-12-31$1,290,701
Total plan assets at beginning of year2011-12-31$1,340,503
Value of fidelity bond covering the plan2011-12-31$75,000
Total contributions received or receivable from participants2011-12-31$52,388
Expenses. Other expenses not covered elsewhere2011-12-31$66
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-56,939
Net income (gross income less expenses)2011-12-31$-49,806
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,290,701
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,340,503
Assets. Value of participant loans2011-12-31$12,162
Total contributions received or receivable from employer(s)2011-12-31$29,190
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 : EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total income from all sources2010-12-31$220,085
Expenses. Total of all expenses incurred2010-12-31$5,919
Benefits paid (including direct rollovers)2010-12-31$5,811
Total plan assets at end of year2010-12-31$1,340,503
Total plan assets at beginning of year2010-12-31$1,126,337
Value of fidelity bond covering the plan2010-12-31$75,000
Total contributions received or receivable from participants2010-12-31$47,888
Expenses. Other expenses not covered elsewhere2010-12-31$108
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$143,068
Net income (gross income less expenses)2010-12-31$214,166
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,340,503
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,126,337
Assets. Value of participant loans2010-12-31$20,947
Total contributions received or receivable from employer(s)2010-12-31$29,129
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 : EMPIRE OPTICAL, INC. 401(K) 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 EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST

2014: EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: EMPIRE OPTICAL, INC. 401(K) 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
2010: EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: EMPIRE OPTICAL, INC. 401(K) PROFIT SHARING PLAN AND TRUST 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-710903
Policy instance 1
Insurance contract or identification numberGA-710903
Number of Individuals Covered14
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,821
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 $5,821
Insurance broker organization code?3
Insurance broker nameEDWARD D JONES & CO L P.
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-710903
Policy instance 1
Insurance contract or identification numberGA-710903
Number of Individuals Covered15
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,343
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 $5,343
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-710903
Policy instance 1
Insurance contract or identification numberGA-710903
Number of Individuals Covered14
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,323
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 $5,323
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-710903
Policy instance 1
Insurance contract or identification numberGA-710903
Number of Individuals Covered16
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,204
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-710903
Policy instance 1
Insurance contract or identification numberGA-710903
Number of Individuals Covered16
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,470
Total amount of fees paid to insurance companyUSD $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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