M/D SYSTEMS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan M/D SYSTEMS, INC. 401(K) PS PLAN
401k plan membership statisitcs for M/D SYSTEMS, INC. 401(K) PS PLAN
| Measure | Date | Value |
|---|
| 2014: M/D SYSTEMS, INC. 401(K) PS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 10 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 9 |
| Number of retired or separated participants receiving benefits | 2014-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-11-01 | 0 |
| Total of all active and inactive participants | 2014-11-01 | 9 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-11-01 | 0 |
| Total participants | 2014-11-01 | 9 |
| Number of participants with account balances | 2014-11-01 | 8 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-11-01 | 0 |
| 2013: M/D SYSTEMS, INC. 401(K) PS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 13 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 9 |
| Number of retired or separated participants receiving benefits | 2013-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-11-01 | 4 |
| Total of all active and inactive participants | 2013-11-01 | 13 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-11-01 | 0 |
| Total participants | 2013-11-01 | 13 |
| Number of participants with account balances | 2013-11-01 | 12 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-11-01 | 0 |
| 2012: M/D SYSTEMS, INC. 401(K) PS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 16 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 14 |
| Number of retired or separated participants receiving benefits | 2012-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-11-01 | 2 |
| Total of all active and inactive participants | 2012-11-01 | 16 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-11-01 | 0 |
| Total participants | 2012-11-01 | 16 |
| Number of participants with account balances | 2012-11-01 | 14 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-11-01 | 0 |
| 2011: M/D SYSTEMS, INC. 401(K) PS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 16 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 15 |
| Number of retired or separated participants receiving benefits | 2011-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-11-01 | 2 |
| Total of all active and inactive participants | 2011-11-01 | 17 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-11-01 | 0 |
| Total participants | 2011-11-01 | 17 |
| Number of participants with account balances | 2011-11-01 | 15 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-11-01 | 0 |
| 2010: M/D SYSTEMS, INC. 401(K) PS PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-11-01 | 19 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-11-01 | 17 |
| Number of retired or separated participants receiving benefits | 2010-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-11-01 | 2 |
| Total of all active and inactive participants | 2010-11-01 | 19 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-11-01 | 0 |
| Total participants | 2010-11-01 | 19 |
| Number of participants with account balances | 2010-11-01 | 18 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-11-01 | 0 |
| Measure | Date | Value |
|---|
| 2015 : M/D SYSTEMS, INC. 401(K) PS PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-10-31 | $74,631 |
| Expenses. Total of all expenses incurred | 2015-10-31 | $105,604 |
| Benefits paid (including direct rollovers) | 2015-10-31 | $103,828 |
| Total plan assets at end of year | 2015-10-31 | $1,339,257 |
| Total plan assets at beginning of year | 2015-10-31 | $1,370,230 |
| Value of fidelity bond covering the plan | 2015-10-31 | $150,000 |
| Total contributions received or receivable from participants | 2015-10-31 | $42,165 |
| Expenses. Other expenses not covered elsewhere | 2015-10-31 | $1,776 |
| Other income received | 2015-10-31 | $18,363 |
| Net income (gross income less expenses) | 2015-10-31 | $-30,973 |
| Net plan assets at end of year (total assets less liabilities) | 2015-10-31 | $1,339,257 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-10-31 | $1,370,230 |
| Assets. Value of participant loans | 2015-10-31 | $1,221 |
| Total contributions received or receivable from employer(s) | 2015-10-31 | $14,103 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2015-10-31 | $0 |
| 2014 : M/D SYSTEMS, INC. 401(K) PS PLAN 2014 401k financial data |
|---|
| Transfers to/from the plan | 2014-10-31 | $0 |
| Total income from all sources | 2014-10-31 | $146,790 |
| Expenses. Total of all expenses incurred | 2014-10-31 | $443,223 |
| Benefits paid (including direct rollovers) | 2014-10-31 | $443,148 |
| Total plan assets at end of year | 2014-10-31 | $1,370,230 |
| Total plan assets at beginning of year | 2014-10-31 | $1,666,663 |
| Value of fidelity bond covering the plan | 2014-10-31 | $150,000 |
| Total contributions received or receivable from participants | 2014-10-31 | $35,247 |
| Expenses. Other expenses not covered elsewhere | 2014-10-31 | $75 |
| Contributions received from other sources (not participants or employers) | 2014-10-31 | $0 |
| Other income received | 2014-10-31 | $96,155 |
| Net income (gross income less expenses) | 2014-10-31 | $-296,433 |
| Net plan assets at end of year (total assets less liabilities) | 2014-10-31 | $1,370,230 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-10-31 | $1,666,663 |
| Assets. Value of participant loans | 2014-10-31 | $1,221 |
| Total contributions received or receivable from employer(s) | 2014-10-31 | $15,388 |
| Value of certain deemed distributions of participant loans | 2014-10-31 | $0 |
| Value of corrective distributions | 2014-10-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2014-10-31 | $0 |
| Minimum employer required contribution for this plan year | 2014-10-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2014-10-31 | $0 |
| 2013 : M/D SYSTEMS, INC. 401(K) PS PLAN 2013 401k financial data |
|---|
| Transfers to/from the plan | 2013-10-31 | $0 |
| Total income from all sources | 2013-10-31 | $243,472 |
| Expenses. Total of all expenses incurred | 2013-10-31 | $147,746 |
| Benefits paid (including direct rollovers) | 2013-10-31 | $147,721 |
| Total plan assets at end of year | 2013-10-31 | $1,666,663 |
| Total plan assets at beginning of year | 2013-10-31 | $1,570,937 |
| Value of fidelity bond covering the plan | 2013-10-31 | $150,000 |
| Total contributions received or receivable from participants | 2013-10-31 | $34,701 |
| Expenses. Other expenses not covered elsewhere | 2013-10-31 | $25 |
| Contributions received from other sources (not participants or employers) | 2013-10-31 | $0 |
| Other income received | 2013-10-31 | $191,892 |
| Net income (gross income less expenses) | 2013-10-31 | $95,726 |
| Net plan assets at end of year (total assets less liabilities) | 2013-10-31 | $1,666,663 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-10-31 | $1,570,937 |
| Assets. Value of participant loans | 2013-10-31 | $1,221 |
| Total contributions received or receivable from employer(s) | 2013-10-31 | $16,879 |
| Value of certain deemed distributions of participant loans | 2013-10-31 | $0 |
| Value of corrective distributions | 2013-10-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2013-10-31 | $0 |
| Minimum employer required contribution for this plan year | 2013-10-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2013-10-31 | $0 |
| 2012 : M/D SYSTEMS, INC. 401(K) PS PLAN 2012 401k financial data |
|---|
| Transfers to/from the plan | 2012-10-31 | $0 |
| Total income from all sources | 2012-10-31 | $143,867 |
| Expenses. Total of all expenses incurred | 2012-10-31 | $417,541 |
| Benefits paid (including direct rollovers) | 2012-10-31 | $417,516 |
| Total plan assets at end of year | 2012-10-31 | $1,570,937 |
| Total plan assets at beginning of year | 2012-10-31 | $1,844,611 |
| Value of fidelity bond covering the plan | 2012-10-31 | $150,000 |
| Total contributions received or receivable from participants | 2012-10-31 | $35,452 |
| Expenses. Other expenses not covered elsewhere | 2012-10-31 | $25 |
| Contributions received from other sources (not participants or employers) | 2012-10-31 | $0 |
| Other income received | 2012-10-31 | $89,951 |
| Net income (gross income less expenses) | 2012-10-31 | $-273,674 |
| Net plan assets at end of year (total assets less liabilities) | 2012-10-31 | $1,570,937 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-10-31 | $1,844,611 |
| Assets. Value of participant loans | 2012-10-31 | $5,402 |
| Total contributions received or receivable from employer(s) | 2012-10-31 | $18,464 |
| Value of certain deemed distributions of participant loans | 2012-10-31 | $0 |
| Value of corrective distributions | 2012-10-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2012-10-31 | $0 |
| Minimum employer required contribution for this plan year | 2012-10-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2012-10-31 | $0 |
| 2011 : M/D SYSTEMS, INC. 401(K) PS PLAN 2011 401k financial data |
|---|
| Transfers to/from the plan | 2011-10-31 | $0 |
| Total income from all sources | 2011-10-31 | $294,578 |
| Expenses. Total of all expenses incurred | 2011-10-31 | $52,112 |
| Benefits paid (including direct rollovers) | 2011-10-31 | $39,044 |
| Total plan assets at end of year | 2011-10-31 | $1,844,611 |
| Total plan assets at beginning of year | 2011-10-31 | $1,602,145 |
| Value of fidelity bond covering the plan | 2011-10-31 | $150,000 |
| Total contributions received or receivable from participants | 2011-10-31 | $37,823 |
| Expenses. Other expenses not covered elsewhere | 2011-10-31 | $13,068 |
| Contributions received from other sources (not participants or employers) | 2011-10-31 | $0 |
| Other income received | 2011-10-31 | $237,025 |
| Net income (gross income less expenses) | 2011-10-31 | $242,466 |
| Net plan assets at end of year (total assets less liabilities) | 2011-10-31 | $1,844,611 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-10-31 | $1,602,145 |
| Assets. Value of participant loans | 2011-10-31 | $7,912 |
| Total contributions received or receivable from employer(s) | 2011-10-31 | $19,730 |
| Value of certain deemed distributions of participant loans | 2011-10-31 | $0 |
| Value of corrective distributions | 2011-10-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2011-10-31 | $0 |
| Minimum employer required contribution for this plan year | 2011-10-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2011-10-31 | $0 |
| 2014: M/D SYSTEMS, INC. 401(K) PS PLAN 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Submission has been amended | No |
| 2014-11-01 | This submission is the final filing | No |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-11-01 | Plan is a collectively bargained plan | No |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan funding arrangement – Trust | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: M/D SYSTEMS, INC. 401(K) PS PLAN 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | Submission has been amended | No |
| 2013-11-01 | This submission is the final filing | No |
| 2013-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-11-01 | Plan is a collectively bargained plan | No |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan funding arrangement – Trust | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: M/D SYSTEMS, INC. 401(K) PS PLAN 2012 form 5500 responses |
|---|
| 2012-11-01 | Type of plan entity | Single employer plan |
| 2012-11-01 | Submission has been amended | No |
| 2012-11-01 | This submission is the final filing | No |
| 2012-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-11-01 | Plan is a collectively bargained plan | No |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan funding arrangement – Trust | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: M/D SYSTEMS, INC. 401(K) PS PLAN 2011 form 5500 responses |
|---|
| 2011-11-01 | Type of plan entity | Single employer plan |
| 2011-11-01 | Submission has been amended | No |
| 2011-11-01 | This submission is the final filing | No |
| 2011-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-11-01 | Plan is a collectively bargained plan | No |
| 2011-11-01 | Plan funding arrangement – Insurance | Yes |
| 2011-11-01 | Plan funding arrangement – Trust | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: M/D SYSTEMS, INC. 401(K) PS PLAN 2010 form 5500 responses |
|---|
| 2010-11-01 | Type of plan entity | Single employer plan |
| 2010-11-01 | Submission has been amended | No |
| 2010-11-01 | This submission is the final filing | No |
| 2010-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-11-01 | Plan is a collectively bargained plan | No |
| 2010-11-01 | Plan funding arrangement – Insurance | Yes |
| 2010-11-01 | Plan funding arrangement – Trust | Yes |
| 2010-11-01 | Plan benefit arrangement – Insurance | Yes |
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-825643 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-825643 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $6,878 | | 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 $6,878 | | Insurance broker organization code? | 3 | | Insurance broker name | LPL FINANCIAL CORPORATION |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-825643 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-825643 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $8,004 | | 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 $8,004 | | Insurance broker organization code? | 3 | | Insurance broker name | LPL FINANCIAL CORPORATION |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-825643 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-825643 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $8,175 | | Total amount of fees paid to insurance company | USD $70 | | 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 $8,175 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 70 | | Additional information about fees paid to insurance broker | SALES/MARKETING | | Insurance broker name | LPL FINANCIAL LLC |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-825643 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-825643 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $2,714 | | Total amount of fees paid to insurance company | USD $58 | | 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-825643 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-825643 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $37,367 | | 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 |
|
| MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 ) |
| Policy contract number | FL 9472-1 |
| Policy instance | 2 |
| Insurance contract or identification number | FL 9472-1 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-07-05 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 |
|
