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RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 401k Plan overview

Plan NameRG GOSSELIN INC. PROFIT SHARING 401(K) PLAN
Plan identification number 001

RG GOSSELIN INC. PROFIT SHARING 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.
  • 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

RG GOSSELIN, INC. has sponsored the creation of one or more 401k plans.

Company Name:RG GOSSELIN, INC.
Employer identification number (EIN):030239730
NAIC Classification:238100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01MONICA DELABRUERE2023-07-06
0012021-01-01MONICA DELABRUERE2022-06-24 LORRAINE GOSSELIN2022-06-24
0012020-01-01MONICA DELABRUERE2021-06-23 LORRAINE GOSSELIN2021-06-23
0012019-01-01MONICA DELABRUERE2020-06-23 MONICA DELABRUERE2020-06-23
0012018-01-01MONICA DELABRUERE2019-06-28 MONICA DELABRUERE2019-06-28
0012017-01-01MONICA DELABRUERE2018-06-13 LORRAINE GOSSELIN2018-06-13
0012016-01-01MONICA DELABRUERE2017-06-07 LORRAINE GOSSELIN2017-06-07
0012016-01-01MONICA DELABRUERE2017-06-07 LORRAINE GOSSELIN2017-06-07
0012015-01-01MONICA DELABRUERE2016-06-20 LORRAINE GOSSELIN2016-06-20
0012015-01-01MONICA DELABRUERE2016-06-20 MONICA DELABRUERE2016-06-20
0012014-01-01MONICA DELABRUERE LORRAINE GOSSELIN2015-06-11
0012013-01-01MONICA DELABRUERE
0012012-01-01MONICA DELABRUERE
0012011-01-01MONICA DELABRUERE
0012010-01-01MONICA DELABRUERE
0012009-01-01MONICA DELABRUERE LORRAINE GOSSELIN2010-09-02

Plan Statistics for RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN

401k plan membership statisitcs for RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN

Measure Date Value
2014: RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0143
Total number of active participants reported on line 7a of the Form 55002014-01-0135
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-016
Total of all active and inactive participants2014-01-0141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0141
Number of participants with account balances2014-01-0141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0141
Total number of active participants reported on line 7a of the Form 55002013-01-0136
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-015
Total of all active and inactive participants2013-01-0141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0141
Number of participants with account balances2013-01-0141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0144
Total number of active participants reported on line 7a of the Form 55002012-01-0136
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-016
Total of all active and inactive participants2012-01-0142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0142
Number of participants with account balances2012-01-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0161
Total number of active participants reported on line 7a of the Form 55002011-01-0151
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0151
Number of participants with account balances2011-01-0144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0175
Total number of active participants reported on line 7a of the Form 55002010-01-0167
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 participants2010-01-0167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0167
Number of participants with account balances2010-01-0152
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0179
Total number of active participants reported on line 7a of the Form 55002009-01-0171
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-013
Total of all active and inactive participants2009-01-0174
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0174
Number of participants with account balances2009-01-0158
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-012

Financial Data on RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN

Measure Date Value
2014 : RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total income from all sources2014-12-31$240,655
Expenses. Total of all expenses incurred2014-12-31$18,898
Benefits paid (including direct rollovers)2014-12-31$18,237
Total plan assets at end of year2014-12-31$2,054,349
Total plan assets at beginning of year2014-12-31$1,832,592
Value of fidelity bond covering the plan2014-12-31$200,000
Total contributions received or receivable from participants2014-12-31$92,613
Expenses. Other expenses not covered elsewhere2014-12-31$661
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$80,252
Net income (gross income less expenses)2014-12-31$221,757
Net plan assets at end of year (total assets less liabilities)2014-12-31$2,054,349
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,832,592
Assets. Value of participant loans2014-12-31$32,510
Total contributions received or receivable from employer(s)2014-12-31$67,790
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 : RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total income from all sources2013-12-31$463,182
Expenses. Total of all expenses incurred2013-12-31$13,423
Benefits paid (including direct rollovers)2013-12-31$12,704
Total plan assets at end of year2013-12-31$1,832,592
Total plan assets at beginning of year2013-12-31$1,382,833
Value of fidelity bond covering the plan2013-12-31$200,000
Total contributions received or receivable from participants2013-12-31$94,057
Expenses. Other expenses not covered elsewhere2013-12-31$719
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$301,267
Net income (gross income less expenses)2013-12-31$449,759
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,832,592
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,382,833
Assets. Value of participant loans2013-12-31$29,035
Total contributions received or receivable from employer(s)2013-12-31$67,858
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 : RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total income from all sources2012-12-31$313,060
Expenses. Total of all expenses incurred2012-12-31$54,444
Benefits paid (including direct rollovers)2012-12-31$53,721
Total plan assets at end of year2012-12-31$1,382,833
Total plan assets at beginning of year2012-12-31$1,124,217
Value of fidelity bond covering the plan2012-12-31$200,000
Total contributions received or receivable from participants2012-12-31$88,437
Expenses. Other expenses not covered elsewhere2012-12-31$723
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$160,765
Net income (gross income less expenses)2012-12-31$258,616
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,382,833
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,124,217
Assets. Value of participant loans2012-12-31$29,922
Total contributions received or receivable from employer(s)2012-12-31$63,858
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 : RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total income from all sources2011-12-31$86,837
Expenses. Total of all expenses incurred2011-12-31$225,030
Benefits paid (including direct rollovers)2011-12-31$224,428
Total plan assets at end of year2011-12-31$1,124,217
Total plan assets at beginning of year2011-12-31$1,262,410
Value of fidelity bond covering the plan2011-12-31$200,000
Total contributions received or receivable from participants2011-12-31$74,484
Expenses. Other expenses not covered elsewhere2011-12-31$602
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-50,826
Net income (gross income less expenses)2011-12-31$-138,193
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,124,217
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,262,410
Assets. Value of participant loans2011-12-31$13,264
Total contributions received or receivable from employer(s)2011-12-31$63,179
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 : RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total income from all sources2010-12-31$304,896
Expenses. Total of all expenses incurred2010-12-31$87,007
Benefits paid (including direct rollovers)2010-12-31$85,793
Total plan assets at end of year2010-12-31$1,262,410
Total plan assets at beginning of year2010-12-31$1,044,521
Value of fidelity bond covering the plan2010-12-31$150,000
Total contributions received or receivable from participants2010-12-31$87,511
Expenses. Other expenses not covered elsewhere2010-12-31$1,214
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$147,751
Net income (gross income less expenses)2010-12-31$217,889
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,262,410
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,044,521
Assets. Value of participant loans2010-12-31$12,639
Total contributions received or receivable from employer(s)2010-12-31$69,634
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 : RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 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 RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN

2014: RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 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: RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 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: RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 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: RG GOSSELIN INC. PROFIT SHARING 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
2010: RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 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: RG GOSSELIN INC. PROFIT SHARING 401(K) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01First time form 5500 has been submittedYes
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-811806
Policy instance 1
Insurance contract or identification numberGA-811806
Number of Individuals Covered41
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,607
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 $4,607
Insurance broker organization code?3
Insurance broker nameWOODBURY FIN SVCS INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-811806
Policy instance 1
Insurance contract or identification numberGA-811806
Number of Individuals Covered41
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,660
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 $3,660
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SVCS INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-811806
Policy instance 1
Insurance contract or identification numberGA-811806
Number of Individuals Covered36
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,020
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 $3,020
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SVCS INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-811806
Policy instance 1
Insurance contract or identification numberGA-811806
Number of Individuals Covered44
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,125
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-811806
Policy instance 1
Insurance contract or identification numberGA-811806
Number of Individuals Covered52
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,003
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,003
Insurance broker organization code?3
Insurance broker nameWOODBURY FINANCIAL SVCS INC

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