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JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 401k Plan overview

Plan NameJEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN
Plan identification number 002

JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

JEWISH FAMILY SERVICE OF BUFFALO has sponsored the creation of one or more 401k plans.

Company Name:JEWISH FAMILY SERVICE OF BUFFALO
Employer identification number (EIN):160760888
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01CAROL QUARANTILLO2023-07-27
0022021-01-01CARLO QUARANTILLO2022-06-01
0022020-01-01CARLO QUARANTILLO2021-06-08
0022019-01-01TERRY CAMANN2020-10-13
0022018-01-01TERRY CAMANN2019-09-03
0022017-01-01TERRY CAMANN2018-06-20 TERRY CAMANN2018-06-20
0022016-01-01TERRY CAMANN2017-06-27
0022015-01-01TERRY CAMANN2016-06-10
0022014-01-01TERRY CAMANN
0022013-01-01TERRY CAMANN
0022012-01-01TERRY CAMANN TERRY CAMANN2013-07-24
0022011-01-01TERRY CAMANN
0022009-01-01
0022009-01-01TERRY CAMANN
0022008-01-01TERRY CAMANN

Plan Statistics for JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN

401k plan membership statisitcs for JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN

Measure Date Value
2014: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0124
Total number of active participants reported on line 7a of the Form 55002014-01-0119
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-011
Total of all active and inactive participants2014-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-011
Total participants2014-01-0121
Number of participants with account balances2014-01-0121
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-011
2013: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0121
Total number of active participants reported on line 7a of the Form 55002013-01-0119
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-011
Total of all active and inactive participants2013-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-011
Total participants2013-01-0121
Number of participants with account balances2013-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0124
Total number of active participants reported on line 7a of the Form 55002012-01-0119
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-011
Total participants2012-01-0120
Number of participants with account balances2012-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-012
2011: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0122
Total number of active participants reported on line 7a of the Form 55002011-01-0119
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 participants2011-01-0121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0121
Number of participants with account balances2011-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0117
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 benefits2009-01-013
Total of all active and inactive participants2009-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0120
Number of participants with account balances2009-01-0120
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-011
2008: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-0119
Total number of active participants reported on line 7a of the Form 55002008-01-0113
Number of retired or separated participants receiving benefits2008-01-010
Number of other retired or separated participants entitled to future benefits2008-01-015
Total of all active and inactive participants2008-01-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2008-01-010
Total participants2008-01-0118
Number of participants with account balances2008-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2008-01-013

Financial Data on JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN

Measure Date Value
2014 : JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$226
Total income from all sources2014-12-31$98,961
Expenses. Total of all expenses incurred2014-12-31$52,570
Benefits paid (including direct rollovers)2014-12-31$52,360
Total plan assets at end of year2014-12-31$681,905
Total plan assets at beginning of year2014-12-31$635,288
Value of fidelity bond covering the plan2014-12-31$900,000
Total contributions received or receivable from participants2014-12-31$57,021
Expenses. Other expenses not covered elsewhere2014-12-31$210
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$21,111
Net income (gross income less expenses)2014-12-31$46,391
Net plan assets at end of year (total assets less liabilities)2014-12-31$681,905
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$635,288
Assets. Value of participant loans2014-12-31$2,292
Total contributions received or receivable from employer(s)2014-12-31$20,829
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 : JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total income from all sources2013-12-31$160,511
Expenses. Total of all expenses incurred2013-12-31$78,619
Benefits paid (including direct rollovers)2013-12-31$78,087
Total plan assets at end of year2013-12-31$635,288
Total plan assets at beginning of year2013-12-31$553,396
Value of fidelity bond covering the plan2013-12-31$900,000
Total contributions received or receivable from participants2013-12-31$66,746
Expenses. Other expenses not covered elsewhere2013-12-31$246
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$71,830
Net income (gross income less expenses)2013-12-31$81,892
Net plan assets at end of year (total assets less liabilities)2013-12-31$635,288
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$553,396
Assets. Value of participant loans2013-12-31$5,289
Total contributions received or receivable from employer(s)2013-12-31$21,935
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$286
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 : JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total income from all sources2012-12-31$142,305
Expenses. Total of all expenses incurred2012-12-31$22,770
Benefits paid (including direct rollovers)2012-12-31$22,402
Total plan assets at end of year2012-12-31$553,396
Total plan assets at beginning of year2012-12-31$433,861
Value of fidelity bond covering the plan2012-12-31$900,000
Total contributions received or receivable from participants2012-12-31$68,115
Expenses. Other expenses not covered elsewhere2012-12-31$368
Contributions received from other sources (not participants or employers)2012-12-31$3,518
Other income received2012-12-31$47,027
Net income (gross income less expenses)2012-12-31$119,535
Net plan assets at end of year (total assets less liabilities)2012-12-31$553,396
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$433,861
Assets. Value of participant loans2012-12-31$12,789
Total contributions received or receivable from employer(s)2012-12-31$23,645
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 : JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total income from all sources2011-12-31$72,902
Expenses. Total of all expenses incurred2011-12-31$25,754
Benefits paid (including direct rollovers)2011-12-31$25,291
Total plan assets at end of year2011-12-31$433,861
Total plan assets at beginning of year2011-12-31$386,713
Value of fidelity bond covering the plan2011-12-31$900,000
Total contributions received or receivable from participants2011-12-31$65,348
Expenses. Other expenses not covered elsewhere2011-12-31$463
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-16,507
Net income (gross income less expenses)2011-12-31$47,148
Net plan assets at end of year (total assets less liabilities)2011-12-31$433,861
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$386,713
Assets. Value of participant loans2011-12-31$10,167
Total contributions received or receivable from employer(s)2011-12-31$24,061
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 : JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total income from all sources2010-12-31$108,262
Expenses. Total of all expenses incurred2010-12-31$734
Benefits paid (including direct rollovers)2010-12-31$145
Total plan assets at end of year2010-12-31$386,713
Total plan assets at beginning of year2010-12-31$279,185
Value of fidelity bond covering the plan2010-12-31$900,000
Total contributions received or receivable from participants2010-12-31$53,783
Expenses. Other expenses not covered elsewhere2010-12-31$589
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$34,131
Net income (gross income less expenses)2010-12-31$107,528
Net plan assets at end of year (total assets less liabilities)2010-12-31$386,713
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$279,185
Assets. Value of participant loans2010-12-31$13,682
Total contributions received or receivable from employer(s)2010-12-31$20,348
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 : JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 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
2008 : JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2008 401k financial data
Total income from all sources2008-12-31$94,875
Expenses. Total of all expenses incurred2008-12-31$4,746
Benefits paid (including direct rollovers)2008-12-31$4,307
Total plan assets at end of year2008-12-31$156,168
Total plan assets at beginning of year2008-12-31$66,039
Value of fidelity bond covering the plan2008-12-31$900,000
Total contributions received or receivable from participants2008-12-31$47,869
Expenses. Other expenses not covered elsewhere2008-12-31$439
Contributions received from other sources (not participants or employers)2008-12-31$64,442
Other income received2008-12-31$-35,246
Net income (gross income less expenses)2008-12-31$90,129
Net plan assets at end of year (total assets less liabilities)2008-12-31$156,168
Net plan assets at beginning of year (total assets less liabilities)2008-12-31$66,039
Assets. Value of participant loans2008-12-31$1,641
Total contributions received or receivable from employer(s)2008-12-31$17,810
Value of corrective distributions2008-12-31$0

Form 5500 Responses for JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN

2014: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 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: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 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: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 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: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 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
2009: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 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
2008: JEWISH FAMILY SERVICE OF BUFFALO & ERIE COUNTY 401(K) PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Submission has been amendedNo
2008-01-01This submission is the final filingNo
2008-01-01This return/report is a short plan year return/report (less than 12 months)No
2008-01-01Plan is a collectively bargained planNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan funding arrangement – TrustYes
2008-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-805239
Policy instance 1
Insurance contract or identification numberGA-805239
Number of Individuals Covered21
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,546
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 $2,546
Insurance broker organization code?3
Insurance broker nameM & T SECURITIES INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-805239
Policy instance 1
Insurance contract or identification numberGA-805239
Number of Individuals Covered20
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,214
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 $2,214
Insurance broker organization code?3
Insurance broker nameM & T SECURITIES INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-805239
Policy instance 1
Insurance contract or identification numberGA-805239
Number of Individuals Covered20
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,829
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 $1,829
Insurance broker organization code?3
Insurance broker nameM & T SECURITIES INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-805239
Policy instance 1
Insurance contract or identification numberGA-805239
Number of Individuals Covered21
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,526
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-805239
Policy instance 1
Insurance contract or identification numberGA-805239
Number of Individuals Covered20
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,187
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-805239
Policy instance 1
Insurance contract or identification numberGA-805239
Number of Individuals Covered18
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $427
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
Commission paid to Insurance BrokerUSD $427
Insurance broker organization code?3
Insurance broker nameM & T SECURITIES INC.

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