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TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 401k Plan overview

Plan NameTRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN
Plan identification number 004

TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT 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

TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:TRI-STATE WHOLESALE BUILDING SUPPLIES, INC.
Employer identification number (EIN):310821964
NAIC Classification:326100

Additional information about TRI-STATE WHOLESALE BUILDING SUPPLIES, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1972-06-19
Company Identification Number: 426265
Legal Registered Office Address: 255 E 5TH ST ,#2400
-
CINCINNATI
United States of America (USA)
45202

More information about TRI-STATE WHOLESALE BUILDING SUPPLIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0042022-01-01
0042022-01-01
0042021-01-01
0042020-01-01
0042019-01-01
0042018-03-01
0042017-03-01
0042016-02-29JASON WELCH
0042015-03-01JASON WELCH
0042014-03-01JOE MORGAN
0042013-03-01JOE MORGAN
0042012-02-29DONALD MORGAN DONALD MORGAN2013-08-21
0042011-03-01DONALD MORGAN
0042010-03-01DONALD MORGAN DONALD MORGAN2011-08-12
0042009-03-01DONALD MORGAN DONALD MORGAN2011-03-24

Plan Statistics for TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN

401k plan membership statisitcs for TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN

Measure Date Value
2016: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-2931
Total number of active participants reported on line 7a of the Form 55002016-02-2927
Number of retired or separated participants receiving benefits2016-02-290
Number of other retired or separated participants entitled to future benefits2016-02-294
Total of all active and inactive participants2016-02-2931
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-02-290
Total participants2016-02-2931
Number of participants with account balances2016-02-2920
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-02-290
2015: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-03-0131
Total number of active participants reported on line 7a of the Form 55002015-03-0129
Number of retired or separated participants receiving benefits2015-03-010
Number of other retired or separated participants entitled to future benefits2015-03-012
Total of all active and inactive participants2015-03-0131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-03-010
Total participants2015-03-0131
Number of participants with account balances2015-03-0117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-03-010
2014: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-03-0128
Total number of active participants reported on line 7a of the Form 55002014-03-0129
Number of retired or separated participants receiving benefits2014-03-010
Number of other retired or separated participants entitled to future benefits2014-03-012
Total of all active and inactive participants2014-03-0131
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-03-010
Total participants2014-03-0131
Number of participants with account balances2014-03-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-03-010
2013: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-03-0141
Total number of active participants reported on line 7a of the Form 55002013-03-0124
Number of retired or separated participants receiving benefits2013-03-010
Number of other retired or separated participants entitled to future benefits2013-03-014
Total of all active and inactive participants2013-03-0128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-03-010
Total participants2013-03-0128
Number of participants with account balances2013-03-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-03-010
2012: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-2955
Total number of active participants reported on line 7a of the Form 55002012-02-2927
Number of retired or separated participants receiving benefits2012-02-291
Number of other retired or separated participants entitled to future benefits2012-02-2913
Total of all active and inactive participants2012-02-2941
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-02-290
Total participants2012-02-2941
Number of participants with account balances2012-02-2935
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-02-290
2011: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-03-0140
Total number of active participants reported on line 7a of the Form 55002011-03-0125
Number of retired or separated participants receiving benefits2011-03-010
Number of other retired or separated participants entitled to future benefits2011-03-010
Total of all active and inactive participants2011-03-0125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-03-010
Total participants2011-03-0125
Number of participants with account balances2011-03-0125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-03-010
2010: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-03-0141
Total number of active participants reported on line 7a of the Form 55002010-03-0126
Number of retired or separated participants receiving benefits2010-03-010
Number of other retired or separated participants entitled to future benefits2010-03-0110
Total of all active and inactive participants2010-03-0136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-03-010
Total participants2010-03-0136
Number of participants with account balances2010-03-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-03-010
2009: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-03-0128
Total number of active participants reported on line 7a of the Form 55002009-03-0127
Number of retired or separated participants receiving benefits2009-03-010
Number of other retired or separated participants entitled to future benefits2009-03-0112
Total of all active and inactive participants2009-03-0139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-03-010
Total participants2009-03-0139
Number of participants with account balances2009-03-0137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-03-010

Financial Data on TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN

Measure Date Value
2017 : TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2017 401k financial data
Transfers to/from the plan2017-02-28$0
Total plan liabilities at end of year2017-02-28$0
Total plan liabilities at beginning of year2017-02-28$0
Total income from all sources2017-02-28$408,196
Expenses. Total of all expenses incurred2017-02-28$113,077
Benefits paid (including direct rollovers)2017-02-28$108,641
Total plan assets at end of year2017-02-28$2,386,561
Total plan assets at beginning of year2017-02-28$2,091,442
Value of fidelity bond covering the plan2017-02-28$300,000
Total contributions received or receivable from participants2017-02-28$43,603
Expenses. Other expenses not covered elsewhere2017-02-28$0
Contributions received from other sources (not participants or employers)2017-02-28$0
Other income received2017-02-28$335,576
Noncash contributions received2017-02-28$0
Net income (gross income less expenses)2017-02-28$295,119
Net plan assets at end of year (total assets less liabilities)2017-02-28$2,386,561
Net plan assets at beginning of year (total assets less liabilities)2017-02-28$2,091,442
Assets. Value of participant loans2017-02-28$142,203
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022017-02-28$0
Total contributions received or receivable from employer(s)2017-02-28$29,017
Value of certain deemed distributions of participant loans2017-02-28$0
Value of corrective distributions2017-02-28$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-02-28$4,436
2016 : TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2016 401k financial data
Transfers to/from the plan2016-02-28$0
Total plan liabilities at end of year2016-02-28$0
Total plan liabilities at beginning of year2016-02-28$0
Total income from all sources2016-02-28$-98,331
Expenses. Total of all expenses incurred2016-02-28$4,418
Benefits paid (including direct rollovers)2016-02-28$0
Total plan assets at end of year2016-02-28$2,091,442
Total plan assets at beginning of year2016-02-28$2,194,191
Value of fidelity bond covering the plan2016-02-28$300,000
Total contributions received or receivable from participants2016-02-28$38,657
Expenses. Other expenses not covered elsewhere2016-02-28$0
Contributions received from other sources (not participants or employers)2016-02-28$0
Other income received2016-02-28$-163,477
Noncash contributions received2016-02-28$0
Net income (gross income less expenses)2016-02-28$-102,749
Net plan assets at end of year (total assets less liabilities)2016-02-28$2,091,442
Net plan assets at beginning of year (total assets less liabilities)2016-02-28$2,194,191
Assets. Value of participant loans2016-02-28$83,865
Total contributions received or receivable from employer(s)2016-02-28$26,489
Value of certain deemed distributions of participant loans2016-02-28$0
Value of corrective distributions2016-02-28$0
Expenses. Administrative service providers (salaries,fees and commissions)2016-02-28$4,418
2015 : TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2015 401k financial data
Transfers to/from the plan2015-02-28$0
Total plan liabilities at end of year2015-02-28$0
Total plan liabilities at beginning of year2015-02-28$0
Total income from all sources2015-02-28$191,568
Expenses. Total of all expenses incurred2015-02-28$125,115
Benefits paid (including direct rollovers)2015-02-28$120,610
Total plan assets at end of year2015-02-28$2,194,191
Total plan assets at beginning of year2015-02-28$2,127,738
Value of fidelity bond covering the plan2015-02-28$300,000
Total contributions received or receivable from participants2015-02-28$34,959
Expenses. Other expenses not covered elsewhere2015-02-28$0
Contributions received from other sources (not participants or employers)2015-02-28$0
Other income received2015-02-28$133,612
Noncash contributions received2015-02-28$0
Net income (gross income less expenses)2015-02-28$66,453
Net plan assets at end of year (total assets less liabilities)2015-02-28$2,194,191
Net plan assets at beginning of year (total assets less liabilities)2015-02-28$2,127,738
Assets. Value of participant loans2015-02-28$89,361
Total contributions received or receivable from employer(s)2015-02-28$22,997
Value of certain deemed distributions of participant loans2015-02-28$0
Value of corrective distributions2015-02-28$0
Expenses. Administrative service providers (salaries,fees and commissions)2015-02-28$4,505
2014 : TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2014 401k financial data
Transfers to/from the plan2014-02-28$0
Total plan liabilities at end of year2014-02-28$0
Total income from all sources2014-02-28$337,119
Expenses. Total of all expenses incurred2014-02-28$464,367
Benefits paid (including direct rollovers)2014-02-28$459,950
Total plan assets at end of year2014-02-28$2,127,738
Total plan assets at beginning of year2014-02-28$2,254,986
Value of fidelity bond covering the plan2014-02-28$300,000
Total contributions received or receivable from participants2014-02-28$33,172
Expenses. Other expenses not covered elsewhere2014-02-28$0
Contributions received from other sources (not participants or employers)2014-02-28$0
Other income received2014-02-28$281,567
Noncash contributions received2014-02-28$0
Net income (gross income less expenses)2014-02-28$-127,248
Net plan assets at end of year (total assets less liabilities)2014-02-28$2,127,738
Net plan assets at beginning of year (total assets less liabilities)2014-02-28$2,254,986
Assets. Value of participant loans2014-02-28$51,514
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022014-02-28$0
Total contributions received or receivable from employer(s)2014-02-28$22,380
Value of certain deemed distributions of participant loans2014-02-28$0
Value of corrective distributions2014-02-28$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-02-28$4,417
2013 : TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2013 401k financial data
Total income from all sources2013-02-28$267,812
Expenses. Total of all expenses incurred2013-02-28$14,915
Benefits paid (including direct rollovers)2013-02-28$14,006
Total plan assets at end of year2013-02-28$2,254,986
Total plan assets at beginning of year2013-02-28$2,002,089
Value of fidelity bond covering the plan2013-02-28$200,000
Total contributions received or receivable from participants2013-02-28$40,931
Other income received2013-02-28$198,283
Net income (gross income less expenses)2013-02-28$252,897
Net plan assets at end of year (total assets less liabilities)2013-02-28$2,254,986
Net plan assets at beginning of year (total assets less liabilities)2013-02-28$2,002,089
Assets. Value of participant loans2013-02-28$109,921
Total contributions received or receivable from employer(s)2013-02-28$28,598
Expenses. Administrative service providers (salaries,fees and commissions)2013-02-28$909
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-02-28$0
2012 : TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2012 401k financial data
Transfers to/from the plan2012-02-29$0
Total income from all sources2012-02-29$119,098
Expenses. Total of all expenses incurred2012-02-29$343,997
Benefits paid (including direct rollovers)2012-02-29$343,538
Total plan assets at end of year2012-02-29$2,002,089
Total plan assets at beginning of year2012-02-29$2,226,988
Value of fidelity bond covering the plan2012-02-29$200,000
Total contributions received or receivable from participants2012-02-29$49,058
Expenses. Other expenses not covered elsewhere2012-02-29$459
Contributions received from other sources (not participants or employers)2012-02-29$0
Other income received2012-02-29$35,230
Net income (gross income less expenses)2012-02-29$-224,899
Net plan assets at end of year (total assets less liabilities)2012-02-29$2,002,089
Net plan assets at beginning of year (total assets less liabilities)2012-02-29$2,226,988
Assets. Value of participant loans2012-02-29$101,669
Total contributions received or receivable from employer(s)2012-02-29$34,810
Value of certain deemed distributions of participant loans2012-02-29$0
Value of corrective distributions2012-02-29$0
Funding deficiency by the employer to the plan for this plan year2012-02-29$0
Minimum employer required contribution for this plan year2012-02-29$0
Amount contributed by the employer to the plan for this plan year2012-02-29$0
2011 : TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2011 401k financial data
Transfers to/from the plan2011-02-28$18
Total income from all sources2011-02-28$385,325
Expenses. Total of all expenses incurred2011-02-28$226
Benefits paid (including direct rollovers)2011-02-28$0
Total plan assets at end of year2011-02-28$2,226,988
Total plan assets at beginning of year2011-02-28$1,841,871
Value of fidelity bond covering the plan2011-02-28$200,000
Total contributions received or receivable from participants2011-02-28$54,862
Expenses. Other expenses not covered elsewhere2011-02-28$226
Contributions received from other sources (not participants or employers)2011-02-28$0
Other income received2011-02-28$290,879
Net income (gross income less expenses)2011-02-28$385,099
Net plan assets at end of year (total assets less liabilities)2011-02-28$2,226,988
Net plan assets at beginning of year (total assets less liabilities)2011-02-28$1,841,871
Assets. Value of participant loans2011-02-28$82,772
Total contributions received or receivable from employer(s)2011-02-28$39,584
Value of certain deemed distributions of participant loans2011-02-28$0
Value of corrective distributions2011-02-28$0
2010 : TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2010 401k financial data
Funding deficiency by the employer to the plan for this plan year2010-02-28$0
Minimum employer required contribution for this plan year2010-02-28$0
Amount contributed by the employer to the plan for this plan year2010-02-28$0

Form 5500 Responses for TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN

2016: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2016 form 5500 responses
2016-02-29Type of plan entitySingle employer plan
2016-02-29Submission has been amendedNo
2016-02-29This submission is the final filingNo
2016-02-29This return/report is a short plan year return/report (less than 12 months)No
2016-02-29Plan is a collectively bargained planNo
2016-02-29Plan funding arrangement – TrustYes
2016-02-29Plan benefit arrangement - TrustYes
2015: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2015 form 5500 responses
2015-03-01Type of plan entitySingle employer plan
2015-03-01Submission has been amendedNo
2015-03-01This submission is the final filingNo
2015-03-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-03-01Plan is a collectively bargained planNo
2015-03-01Plan funding arrangement – TrustYes
2015-03-01Plan benefit arrangement - TrustYes
2014: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2014 form 5500 responses
2014-03-01Type of plan entitySingle employer plan
2014-03-01Submission has been amendedNo
2014-03-01This submission is the final filingNo
2014-03-01This return/report is a short plan year return/report (less than 12 months)No
2014-03-01Plan is a collectively bargained planNo
2014-03-01Plan funding arrangement – TrustYes
2014-03-01Plan benefit arrangement - TrustYes
2013: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2013 form 5500 responses
2013-03-01Type of plan entitySingle employer plan
2013-03-01Submission has been amendedNo
2013-03-01This submission is the final filingNo
2013-03-01This return/report is a short plan year return/report (less than 12 months)No
2013-03-01Plan is a collectively bargained planNo
2013-03-01Plan funding arrangement – TrustYes
2013-03-01Plan benefit arrangement - TrustYes
2012: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2012 form 5500 responses
2012-02-29Type of plan entitySingle employer plan
2012-02-29Submission has been amendedNo
2012-02-29This submission is the final filingNo
2012-02-29This return/report is a short plan year return/report (less than 12 months)No
2012-02-29Plan funding arrangement – InsuranceYes
2012-02-29Plan funding arrangement – TrustYes
2012-02-29Plan benefit arrangement – InsuranceYes
2012-02-29Plan benefit arrangement - TrustYes
2011: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2011 form 5500 responses
2011-03-01Type of plan entitySingle employer plan
2011-03-01Submission has been amendedNo
2011-03-01This submission is the final filingNo
2011-03-01This return/report is a short plan year return/report (less than 12 months)No
2011-03-01Plan is a collectively bargained planNo
2011-03-01Plan funding arrangement – InsuranceYes
2011-03-01Plan funding arrangement – TrustYes
2011-03-01Plan benefit arrangement – InsuranceYes
2010: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2010 form 5500 responses
2010-03-01Type of plan entitySingle employer plan
2010-03-01Submission has been amendedNo
2010-03-01This submission is the final filingNo
2010-03-01This return/report is a short plan year return/report (less than 12 months)No
2010-03-01Plan is a collectively bargained planNo
2010-03-01Plan funding arrangement – InsuranceYes
2010-03-01Plan funding arrangement – TrustYes
2010-03-01Plan benefit arrangement – InsuranceYes
2009: TRI-STATE WHOLESALE BUILDING SUPPLIES, INC. EMPLOYEES' RETIREMENT PLAN 2009 form 5500 responses
2009-03-01Type of plan entitySingle employer plan
2009-03-01Submission has been amendedYes
2009-03-01This submission is the final filingNo
2009-03-01This return/report is a short plan year return/report (less than 12 months)No
2009-03-01Plan is a collectively bargained planNo
2009-03-01Plan funding arrangement – InsuranceYes
2009-03-01Plan funding arrangement – TrustYes
2009-03-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-712062
Policy instance 1
Insurance contract or identification numberGA-712062
Number of Individuals Covered0
Insurance policy start date2012-02-29
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-712062
Policy instance 1
Insurance contract or identification numberGA-712062
Number of Individuals Covered25
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $5,675
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-712062
Policy instance 1
Insurance contract or identification numberGA-712062
Number of Individuals Covered36
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $3,037
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 $2,680
Insurance broker organization code?3
Insurance broker nameNATIONAL CITY INS GRP INC

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