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WERNER NATIONAL, LLC 401(K) PLAN 401k Plan overview

Plan NameWERNER NATIONAL, LLC 401(K) PLAN
Plan identification number 001

WERNER NATIONAL, LLC 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.

401k Sponsoring company profile

WERNER NATIONAL, LLC has sponsored the creation of one or more 401k plans.

Company Name:WERNER NATIONAL, LLC
Employer identification number (EIN):261531474
NAIC Classification:238210
NAIC Description:Electrical Contractors and Other Wiring Installation Contractors

Additional information about WERNER NATIONAL, LLC

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2007-11-30
Company Identification Number: 0800904279
Legal Registered Office Address: PO BOX 2278

RED OAK
United States of America (USA)
75154

More information about WERNER NATIONAL, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WERNER NATIONAL, LLC 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01
0012021-01-01
0012020-01-01KIM WERNER2021-06-14 KIM WERNER2021-06-14
0012019-01-01KIM WERNER2020-10-09 KIM WERNER2020-10-09
0012018-01-01KIM WERNER2019-08-16 KIM WERNER2019-08-16
0012017-01-01MIKE WERNER2018-07-23 MIKE WERNER2018-07-23
0012016-01-01MICHAEL G. WERNER2017-07-25 MICHAEL G. WERNER2017-07-25
0012015-01-01KIM WERNER2016-06-17 KIM WERNER2016-06-17
0012014-01-01KIM WERNER
0012013-01-01MICHAEL CARPENTER MICHAEL CARPENTER2014-06-19
0012012-01-01KIM WERNER
0012011-01-01KIM WERNER
0012010-01-01KIM WERNER

Plan Statistics for WERNER NATIONAL, LLC 401(K) PLAN

401k plan membership statisitcs for WERNER NATIONAL, LLC 401(K) PLAN

Measure Date Value
2022: WERNER NATIONAL, LLC 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0120
Total number of active participants reported on line 7a of the Form 55002022-01-0114
Number of retired or separated participants receiving benefits2022-01-011
Number of other retired or separated participants entitled to future benefits2022-01-012
Total of all active and inactive participants2022-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-0117
Number of participants with account balances2022-01-0117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-010
2021: WERNER NATIONAL, LLC 401(K) PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0122
Total number of active participants reported on line 7a of the Form 55002021-01-0115
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-015
Total of all active and inactive participants2021-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2021-01-010
Total participants2021-01-0120
Number of participants with account balances2021-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2021-01-010
2014: WERNER NATIONAL, LLC 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0120
Total number of active participants reported on line 7a of the Form 55002014-01-0117
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-013
Total of all active and inactive participants2014-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0120
Number of participants with account balances2014-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-011
2013: WERNER NATIONAL, LLC 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0113
Total number of active participants reported on line 7a of the Form 55002013-01-0112
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-012
Total of all active and inactive participants2013-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0114
Number of participants with account balances2013-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: WERNER NATIONAL, LLC 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0112
Total number of active participants reported on line 7a of the Form 55002012-01-0112
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 participants2012-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0114
Number of participants with account balances2012-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: WERNER NATIONAL, LLC 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-019
Total number of active participants reported on line 7a of the Form 55002011-01-019
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 participants2011-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-019
Number of participants with account balances2011-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: WERNER NATIONAL, LLC 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-016
Total number of active participants reported on line 7a of the Form 55002010-01-019
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 participants2010-01-019
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-019
Number of participants with account balances2010-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010

Financial Data on WERNER NATIONAL, LLC 401(K) PLAN

Measure Date Value
2022 : WERNER NATIONAL, LLC 401(K) PLAN 2022 401k financial data
Transfers to/from the plan2022-12-31$0
Total plan liabilities at end of year2022-12-31$0
Total plan liabilities at beginning of year2022-12-31$0
Total income from all sources2022-12-31$-138,218
Expenses. Total of all expenses incurred2022-12-31$50,120
Benefits paid (including direct rollovers)2022-12-31$27,401
Total plan assets at end of year2022-12-31$2,328,051
Total plan assets at beginning of year2022-12-31$2,516,389
Value of fidelity bond covering the plan2022-12-31$250,000
Total contributions received or receivable from participants2022-12-31$26,502
Expenses. Other expenses not covered elsewhere2022-12-31$0
Contributions received from other sources (not participants or employers)2022-12-31$0
Other income received2022-12-31$-384,720
Noncash contributions received2022-12-31$0
Net income (gross income less expenses)2022-12-31$-188,338
Net plan assets at end of year (total assets less liabilities)2022-12-31$2,328,051
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$2,516,389
Assets. Value of participant loans2022-12-31$40,590
Total contributions received or receivable from employer(s)2022-12-31$220,000
Value of certain deemed distributions of participant loans2022-12-31$0
Value of corrective distributions2022-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$22,719
2021 : WERNER NATIONAL, LLC 401(K) PLAN 2021 401k financial data
Transfers to/from the plan2021-12-31$0
Total plan liabilities at end of year2021-12-31$0
Total plan liabilities at beginning of year2021-12-31$0
Total income from all sources2021-12-31$450,806
Expenses. Total of all expenses incurred2021-12-31$170,594
Benefits paid (including direct rollovers)2021-12-31$168,854
Total plan assets at end of year2021-12-31$2,516,389
Total plan assets at beginning of year2021-12-31$2,236,177
Value of fidelity bond covering the plan2021-12-31$50,000
Total contributions received or receivable from participants2021-12-31$17,743
Expenses. Other expenses not covered elsewhere2021-12-31$0
Contributions received from other sources (not participants or employers)2021-12-31$0
Other income received2021-12-31$333,063
Noncash contributions received2021-12-31$0
Net income (gross income less expenses)2021-12-31$280,212
Net plan assets at end of year (total assets less liabilities)2021-12-31$2,516,389
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$2,236,177
Assets. Value of participant loans2021-12-31$29,847
Total contributions received or receivable from employer(s)2021-12-31$100,000
Value of certain deemed distributions of participant loans2021-12-31$0
Value of corrective distributions2021-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$1,740
2014 : WERNER NATIONAL, LLC 401(K) PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total income from all sources2014-12-31$122,360
Expenses. Total of all expenses incurred2014-12-31$1,986
Benefits paid (including direct rollovers)2014-12-31$1,524
Total plan assets at end of year2014-12-31$437,988
Total plan assets at beginning of year2014-12-31$317,614
Value of fidelity bond covering the plan2014-12-31$50,000
Total contributions received or receivable from participants2014-12-31$6,788
Expenses. Other expenses not covered elsewhere2014-12-31$462
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$15,572
Net income (gross income less expenses)2014-12-31$120,374
Net plan assets at end of year (total assets less liabilities)2014-12-31$437,988
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$317,614
Assets. Value of participant loans2014-12-31$4,624
Total contributions received or receivable from employer(s)2014-12-31$100,000
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
2013 : WERNER NATIONAL, LLC 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total income from all sources2013-12-31$124,506
Expenses. Total of all expenses incurred2013-12-31$22,972
Benefits paid (including direct rollovers)2013-12-31$22,472
Total plan assets at end of year2013-12-31$317,614
Total plan assets at beginning of year2013-12-31$216,080
Value of fidelity bond covering the plan2013-12-31$50,000
Total contributions received or receivable from participants2013-12-31$13,283
Expenses. Other expenses not covered elsewhere2013-12-31$500
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$51,223
Net income (gross income less expenses)2013-12-31$101,534
Net plan assets at end of year (total assets less liabilities)2013-12-31$317,614
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$216,080
Assets. Value of participant loans2013-12-31$7,426
Total contributions received or receivable from employer(s)2013-12-31$60,000
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 : WERNER NATIONAL, LLC 401(K) PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total income from all sources2012-12-31$85,730
Expenses. Total of all expenses incurred2012-12-31$364
Benefits paid (including direct rollovers)2012-12-31$0
Total plan assets at end of year2012-12-31$216,080
Total plan assets at beginning of year2012-12-31$130,714
Value of fidelity bond covering the plan2012-12-31$14,000
Total contributions received or receivable from participants2012-12-31$15,298
Expenses. Other expenses not covered elsewhere2012-12-31$364
Contributions received from other sources (not participants or employers)2012-12-31$501
Other income received2012-12-31$19,931
Net income (gross income less expenses)2012-12-31$85,366
Net plan assets at end of year (total assets less liabilities)2012-12-31$216,080
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$130,714
Assets. Value of participant loans2012-12-31$1,500
Total contributions received or receivable from employer(s)2012-12-31$50,000
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
2011 : WERNER NATIONAL, LLC 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total income from all sources2011-12-31$70,747
Expenses. Total of all expenses incurred2011-12-31$2,607
Benefits paid (including direct rollovers)2011-12-31$2,312
Total plan assets at end of year2011-12-31$130,714
Total plan assets at beginning of year2011-12-31$62,574
Value of fidelity bond covering the plan2011-12-31$14,000
Total contributions received or receivable from participants2011-12-31$15,097
Expenses. Other expenses not covered elsewhere2011-12-31$295
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-4,350
Net income (gross income less expenses)2011-12-31$68,140
Net plan assets at end of year (total assets less liabilities)2011-12-31$130,714
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$62,574
Assets. Value of participant loans2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$60,000
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 : WERNER NATIONAL, LLC 401(K) PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total income from all sources2010-12-31$62,822
Expenses. Total of all expenses incurred2010-12-31$248
Benefits paid (including direct rollovers)2010-12-31$0
Total plan assets at end of year2010-12-31$62,574
Total plan assets at beginning of year2010-12-31$0
Value of fidelity bond covering the plan2010-12-31$50,000
Total contributions received or receivable from participants2010-12-31$7,922
Expenses. Other expenses not covered elsewhere2010-12-31$248
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$4,900
Net income (gross income less expenses)2010-12-31$62,574
Net plan assets at end of year (total assets less liabilities)2010-12-31$62,574
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$0
Assets. Value of participant loans2010-12-31$0
Total contributions received or receivable from employer(s)2010-12-31$50,000
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0

Form 5500 Responses for WERNER NATIONAL, LLC 401(K) PLAN

2022: WERNER NATIONAL, LLC 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01This submission is the final filingNo
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: WERNER NATIONAL, LLC 401(K) PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2014: WERNER NATIONAL, LLC 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: WERNER NATIONAL, LLC 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: WERNER NATIONAL, LLC 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: WERNER NATIONAL, LLC 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: WERNER NATIONAL, LLC 401(K) PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01First time form 5500 has been submittedYes
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

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-820219
Policy instance 1
Insurance contract or identification numberGA-820219
Number of Individuals Covered13
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,446
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 $1,446
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-820219
Policy instance 1
Insurance contract or identification numberGA-820219
Number of Individuals Covered13
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,048
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 $1,048
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-820219
Policy instance 1
Insurance contract or identification numberGA-820219
Number of Individuals Covered12
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $695
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 $695
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-820219
Policy instance 1
Insurance contract or identification numberGA-820219
Number of Individuals Covered9
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $407
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-820219
Policy instance 1
Insurance contract or identification numberGA-820219
Number of Individuals Covered9
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $111
Total amount of fees paid to insurance companyUSD $50
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 $111
Insurance broker organization code?3
Amount paid for insurance broker fees50
Additional information about fees paid to insurance brokerSALES/MARKETING
Insurance broker nameWOODBURY FINANCIAL SVCS INC

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