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FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 401k Plan overview

Plan NameFOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH
Plan identification number 001

FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 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.
  • 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.
  • 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

CONSOLIDATED TRIBAL HEALTH has sponsored the creation of one or more 401k plans.

Company Name:CONSOLIDATED TRIBAL HEALTH
Employer identification number (EIN):942891496
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01
0012022-01-01FELIZA WAGGONER2023-10-10
0012021-01-01FELIZA WAGGONER2022-05-23 FELIZA WAGGONER2022-05-23
0012020-01-01FELIZA WAGGONER2021-07-22 FELIZA WAGGONER2021-07-22
0012019-01-01FELIZA WAGGONER2020-07-31 FELIZA WAGGONER2020-07-31
0012018-01-01MELANIE RAFANAN2019-08-05
0012017-01-01MELANIE RAFANAN2018-06-19
0012016-01-01FELIZA WAGGONER2017-06-01
0012015-01-01ROMAN CARRILLO2016-06-28
0012014-01-01PRESTON PETE
0012013-01-01FREDERICK RUNDLET
0012012-01-01FREDERICK RUNDLET FREDERICK RUNDLET2013-06-10
0012011-01-01FREDERICK RUNDLET
0012009-01-01 FREDERICK RUNDLET2010-07-23
0012009-01-01FREDERICK RUNDLET
0012009-01-01FREDERICK RUNDLET
0012009-01-01FREDERICK RUNDLET FREDERICK RUNDLET2010-07-23
0012009-01-01 FREDERICK RUNDLET2010-07-27

Plan Statistics for FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH

401k plan membership statisitcs for FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH

Measure Date Value
2023: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2023 401k membership
Total participants, beginning-of-year2023-01-01128
Total number of active participants reported on line 7a of the Form 55002023-01-0162
Number of retired or separated participants receiving benefits2023-01-010
Number of other retired or separated participants entitled to future benefits2023-01-0169
Total of all active and inactive participants2023-01-01131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2023-01-010
Total participants2023-01-01131
Number of participants with account balances2023-01-01131
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2023-01-010
2014: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2014 401k membership
Total participants, beginning-of-year2014-01-0177
Total number of active participants reported on line 7a of the Form 55002014-01-0158
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0125
Total of all active and inactive participants2014-01-0183
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-011
Total participants2014-01-0184
Number of participants with account balances2014-01-0182
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2013 401k membership
Total participants, beginning-of-year2013-01-0181
Total number of active participants reported on line 7a of the Form 55002013-01-0157
Number of retired or separated participants receiving benefits2013-01-011
Number of other retired or separated participants entitled to future benefits2013-01-0124
Total of all active and inactive participants2013-01-0182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-012
Total participants2013-01-0184
Number of participants with account balances2013-01-0182
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2012 401k membership
Total participants, beginning-of-year2012-01-0173
Total number of active participants reported on line 7a of the Form 55002012-01-0156
Number of retired or separated participants receiving benefits2012-01-012
Number of other retired or separated participants entitled to future benefits2012-01-0121
Total of all active and inactive participants2012-01-0179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-011
Total participants2012-01-0180
Number of participants with account balances2012-01-0159
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2011 401k membership
Total participants, beginning-of-year2011-01-0178
Total number of active participants reported on line 7a of the Form 55002011-01-0157
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0125
Total of all active and inactive participants2011-01-0182
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0182
Number of participants with account balances2011-01-0182
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2009 401k membership
Total participants, beginning-of-year2009-01-0180
Total number of active participants reported on line 7a of the Form 55002009-01-0152
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0129
Total of all active and inactive participants2009-01-0181
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-012
Total participants2009-01-0183
Number of participants with account balances2009-01-0183
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH

Measure Date Value
2023 : FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2023 401k financial data
Total unrealized appreciation/depreciation of assets2023-12-31$0
Total transfer of assets from this plan2023-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Total income from all sources (including contributions)2023-12-31$708,429
Total loss/gain on sale of assets2023-12-31$0
Total of all expenses incurred2023-12-31$1,049,825
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$1,049,654
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$476,695
Value of total assets at end of year2023-12-31$3,233,158
Value of total assets at beginning of year2023-12-31$3,574,554
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$171
Total interest from all sources2023-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2023-12-31$30,448
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2023-12-31$30,448
Was this plan covered by a fidelity bond2023-12-31Yes
Value of fidelity bond cover2023-12-31$358,000
If this is an individual account plan, was there a blackout period2023-12-31No
Were there any nonexempt tranactions with any party-in-interest2023-12-31No
Contributions received from participants2023-12-31$16,435
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Value of net income/loss2023-12-31$-341,396
Value of net assets at end of year (total assets less liabilities)2023-12-31$3,233,158
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$3,574,554
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-12-31No
Were any leases to which the plan was party in default or uncollectible2023-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2023-12-31$3,233,158
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-12-31$3,574,554
Net investment gain/loss from registered investment companies (e.g. mutual funds)2023-12-31$201,286
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-12-31No
Was there a failure to transmit to the plan any participant contributions2023-12-31No
Has the plan failed to provide any benefit when due under the plan2023-12-31No
Contributions received in cash from employer2023-12-31$460,260
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-12-31$1,049,654
Did the plan have assets held for investment2023-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-12-31No
Opinion of an independent qualified public accountant for this plan2023-12-31Unqualified
Accountancy firm name2023-12-31HARSHWAL & COMPANY LLP
Accountancy firm EIN2023-12-31270741376
2014 : FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2014 401k financial data
Transfers to/from the plan2014-12-31$265
Total income from all sources2014-12-31$460,505
Expenses. Total of all expenses incurred2014-12-31$234,524
Benefits paid (including direct rollovers)2014-12-31$234,524
Total plan assets at end of year2014-12-31$1,918,378
Total plan assets at beginning of year2014-12-31$1,692,132
Value of fidelity bond covering the plan2014-12-31$400,000
Total contributions received or receivable from participants2014-12-31$110,234
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$94,336
Other income received2014-12-31$60,039
Net income (gross income less expenses)2014-12-31$225,981
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,918,378
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,692,132
Assets. Value of participant loans2014-12-31$0
Total contributions received or receivable from employer(s)2014-12-31$195,896
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 : FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total income from all sources2013-12-31$595,816
Expenses. Total of all expenses incurred2013-12-31$135,334
Benefits paid (including direct rollovers)2013-12-31$135,334
Total plan assets at end of year2013-12-31$1,692,132
Total plan assets at beginning of year2013-12-31$1,231,650
Value of fidelity bond covering the plan2013-12-31$175,000
Total contributions received or receivable from participants2013-12-31$51,530
Expenses. Other expenses not covered elsewhere2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$307,099
Other income received2013-12-31$44,197
Net income (gross income less expenses)2013-12-31$460,482
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,692,132
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,231,650
Assets. Value of participant loans2013-12-31$0
Total contributions received or receivable from employer(s)2013-12-31$192,990
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 : FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total income from all sources2012-12-31$258,303
Expenses. Total of all expenses incurred2012-12-31$234,633
Benefits paid (including direct rollovers)2012-12-31$234,633
Total plan assets at end of year2012-12-31$1,231,650
Total plan assets at beginning of year2012-12-31$1,207,980
Value of fidelity bond covering the plan2012-12-31$175,000
Total contributions received or receivable from participants2012-12-31$35,085
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$40,287
Net income (gross income less expenses)2012-12-31$23,670
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,231,650
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,207,980
Assets. Value of participant loans2012-12-31$0
Total contributions received or receivable from employer(s)2012-12-31$182,931
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 : FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total income from all sources2011-12-31$245,262
Expenses. Total of all expenses incurred2011-12-31$177,281
Benefits paid (including direct rollovers)2011-12-31$177,281
Total plan assets at end of year2011-12-31$1,207,980
Total plan assets at beginning of year2011-12-31$1,139,999
Value of fidelity bond covering the plan2011-12-31$150,000
Total contributions received or receivable from participants2011-12-31$47,808
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$33,471
Net income (gross income less expenses)2011-12-31$67,981
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,207,980
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,139,999
Assets. Value of participant loans2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$163,983
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 : FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total income from all sources2010-12-31$287,406
Expenses. Total of all expenses incurred2010-12-31$60,363
Benefits paid (including direct rollovers)2010-12-31$53,795
Total plan assets at end of year2010-12-31$1,139,999
Total plan assets at beginning of year2010-12-31$912,956
Value of fidelity bond covering the plan2010-12-31$150,000
Total contributions received or receivable from participants2010-12-31$104,425
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$1,374
Other income received2010-12-31$34,518
Net income (gross income less expenses)2010-12-31$227,043
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,139,999
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$912,956
Assets. Value of participant loans2010-12-31$0
Total contributions received or receivable from employer(s)2010-12-31$147,089
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$6,568
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 : FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 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 FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH

2023: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – TrustYes
2023-01-01Plan benefit arrangement - TrustYes
2014: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 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: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 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: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 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: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 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: FOR THE EMPLOYEES OF CONSOLIDATED TRIBAL HEALTH 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

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-025530
Policy instance 1
Insurance contract or identification numberGA-025530
Number of Individuals Covered82
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $7,658
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 $6,712
Insurance broker organization code?3
Insurance broker nameWELLS FARGO WEALTH BROKERAGE INS
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-025530
Policy instance 1
Insurance contract or identification numberGA-025530
Number of Individuals Covered82
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $8,028
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 $8,028
Insurance broker organization code?3
Insurance broker nameWELLS FARGO WEALTH BRKG INS AGY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-025530
Policy instance 1
Insurance contract or identification numberGA-025530
Number of Individuals Covered59
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,588
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,588
Insurance broker organization code?3
Insurance broker nameWELLS FARGO WEALTH BRKG INS AGY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-025530
Policy instance 1
Insurance contract or identification numberGA-025530
Number of Individuals Covered82
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,767
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-025530
Policy instance 1
Insurance contract or identification numberGA-025530
Number of Individuals Covered81
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,115
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,115
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INVESTMENTS LLC

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