CPI INTERNATIONAL, INC. has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2014: CPI INTERNATIONAL 401(K) PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 43 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 28 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 18 |
| Total of all active and inactive participants | 2014-01-01 | 46 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-01-01 | 0 |
| Total participants | 2014-01-01 | 46 |
| Number of participants with account balances | 2014-01-01 | 27 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-01-01 | 0 |
| 2013: CPI INTERNATIONAL 401(K) PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 36 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 22 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 21 |
| Total of all active and inactive participants | 2013-01-01 | 43 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 0 |
| Total participants | 2013-01-01 | 43 |
| Number of participants with account balances | 2013-01-01 | 28 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-01-01 | 0 |
| 2012: CPI INTERNATIONAL 401(K) PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 32 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 20 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 16 |
| Total of all active and inactive participants | 2012-01-01 | 36 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 0 |
| Total participants | 2012-01-01 | 36 |
| Number of participants with account balances | 2012-01-01 | 20 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-01-01 | 0 |
| 2011: CPI INTERNATIONAL 401(K) PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 29 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 10 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 15 |
| Total of all active and inactive participants | 2011-01-01 | 25 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-01-01 | 0 |
| Total participants | 2011-01-01 | 25 |
| Number of participants with account balances | 2011-01-01 | 25 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-01-01 | 0 |
| 2010: CPI INTERNATIONAL 401(K) PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 28 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 10 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 16 |
| Total of all active and inactive participants | 2010-01-01 | 26 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 26 |
| Number of participants with account balances | 2010-01-01 | 26 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-01-01 | 0 |
| 2009: CPI INTERNATIONAL 401(K) PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 28 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 13 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 15 |
| Total of all active and inactive participants | 2009-01-01 | 28 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 28 |
| Number of participants with account balances | 2009-01-01 | 28 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 0 |
| Measure | Date | Value |
|---|
| 2014 : CPI INTERNATIONAL 401(K) PLAN 2014 401k financial data |
|---|
| Transfers to/from the plan | 2014-12-31 | $573 |
| Total income from all sources | 2014-12-31 | $52,703 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $97,703 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $97,703 |
| Total plan assets at end of year | 2014-12-31 | $333,804 |
| Total plan assets at beginning of year | 2014-12-31 | $378,231 |
| Value of fidelity bond covering the plan | 2014-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $17,463 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2014-12-31 | $0 |
| Other income received | 2014-12-31 | $17,789 |
| Net income (gross income less expenses) | 2014-12-31 | $-45,000 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $333,804 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $378,231 |
| Assets. Value of participant loans | 2014-12-31 | $14,144 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $17,451 |
| Value of certain deemed distributions of participant loans | 2014-12-31 | $0 |
| Value of corrective distributions | 2014-12-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2014-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2014-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2014-12-31 | $0 |
| 2013 : CPI INTERNATIONAL 401(K) PLAN 2013 401k financial data |
|---|
| Transfers to/from the plan | 2013-12-31 | $0 |
| Total income from all sources | 2013-12-31 | $123,404 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $265,388 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $265,388 |
| Total plan assets at end of year | 2013-12-31 | $378,231 |
| Total plan assets at beginning of year | 2013-12-31 | $520,215 |
| Value of fidelity bond covering the plan | 2013-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $25,843 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2013-12-31 | $0 |
| Other income received | 2013-12-31 | $74,160 |
| Net income (gross income less expenses) | 2013-12-31 | $-141,984 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $378,231 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $520,215 |
| Assets. Value of participant loans | 2013-12-31 | $23,285 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $23,401 |
| Value of certain deemed distributions of participant loans | 2013-12-31 | $0 |
| Value of corrective distributions | 2013-12-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2013-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2013-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2013-12-31 | $0 |
| 2012 : CPI INTERNATIONAL 401(K) PLAN 2012 401k financial data |
|---|
| Transfers to/from the plan | 2012-12-31 | $0 |
| Total income from all sources | 2012-12-31 | $99,323 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $151,758 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $151,688 |
| Total plan assets at end of year | 2012-12-31 | $520,215 |
| Total plan assets at beginning of year | 2012-12-31 | $572,650 |
| Value of fidelity bond covering the plan | 2012-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2012-12-31 | $6,293 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $70 |
| Contributions received from other sources (not participants or employers) | 2012-12-31 | $13,210 |
| Other income received | 2012-12-31 | $74,273 |
| Net income (gross income less expenses) | 2012-12-31 | $-52,435 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $520,215 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $572,650 |
| Assets. Value of participant loans | 2012-12-31 | $23,875 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $5,547 |
| Value of certain deemed distributions of participant loans | 2012-12-31 | $0 |
| Value of corrective distributions | 2012-12-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2012-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2012-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2012-12-31 | $0 |
| 2011 : CPI INTERNATIONAL 401(K) PLAN 2011 401k financial data |
|---|
| Transfers to/from the plan | 2011-12-31 | $0 |
| Total income from all sources | 2011-12-31 | $-6,668 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $467,889 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $467,819 |
| Total plan assets at end of year | 2011-12-31 | $572,650 |
| Total plan assets at beginning of year | 2011-12-31 | $1,047,207 |
| Value of fidelity bond covering the plan | 2011-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2011-12-31 | $32,061 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $70 |
| Contributions received from other sources (not participants or employers) | 2011-12-31 | $0 |
| Other income received | 2011-12-31 | $-38,729 |
| Net income (gross income less expenses) | 2011-12-31 | $-474,557 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $572,650 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $1,047,207 |
| Assets. Value of participant loans | 2011-12-31 | $22,264 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $0 |
| Value of certain deemed distributions of participant loans | 2011-12-31 | $0 |
| Value of corrective distributions | 2011-12-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2011-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2011-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2011-12-31 | $0 |
| 2010 : CPI INTERNATIONAL 401(K) PLAN 2010 401k financial data |
|---|
| Transfers to/from the plan | 2010-12-31 | $0 |
| Total income from all sources | 2010-12-31 | $188,832 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $213,965 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $213,825 |
| Total plan assets at end of year | 2010-12-31 | $1,047,207 |
| Total plan assets at beginning of year | 2010-12-31 | $1,072,340 |
| Value of fidelity bond covering the plan | 2010-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2010-12-31 | $23,112 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $140 |
| Contributions received from other sources (not participants or employers) | 2010-12-31 | $0 |
| Other income received | 2010-12-31 | $133,010 |
| Net income (gross income less expenses) | 2010-12-31 | $-25,133 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $1,047,207 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $1,072,340 |
| Assets. Value of participant loans | 2010-12-31 | $73,613 |
| Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102 | 2010-12-31 | $36,354 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $32,710 |
| Value of certain deemed distributions of participant loans | 2010-12-31 | $0 |
| Value of corrective distributions | 2010-12-31 | $0 |
| 2009 : CPI INTERNATIONAL 401(K) PLAN 2009 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2009-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2009-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2009-12-31 | $0 |
| 2014: CPI INTERNATIONAL 401(K) PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: CPI INTERNATIONAL 401(K) PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: CPI INTERNATIONAL 401(K) PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: CPI INTERNATIONAL 401(K) PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: CPI INTERNATIONAL 401(K) PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: CPI INTERNATIONAL 401(K) PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-024733 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-024733 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $908 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Broker | USD $682 | | Insurance broker organization code? | 3 | | Insurance broker name | PORTSMOUTH FINANCIAL SERVICES |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-024733 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-024733 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,123 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Broker | USD $1,123 | | Insurance broker organization code? | 3 | | Insurance broker name | PREFERRED PRODUCT NETWORK INC |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-024733 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-024733 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,585 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Broker | USD $1,179 | | Insurance broker organization code? | 3 | | Insurance broker name | PREFERRED PRODUCT NETWORK INC |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-024733 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-024733 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,277 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 number | GA-024733 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-024733 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,334 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 |
|
