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SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 401k Plan overview

Plan NameSANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN
Plan identification number 001

SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

SANDEE MANUFACTURING COMPANY has sponsored the creation of one or more 401k plans.

Company Name:SANDEE MANUFACTURING COMPANY
Employer identification number (EIN):362048582
NAIC Classification:326100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01ERIN MCLEOD2023-05-30
0012021-01-01ERIN MCLEOD2022-05-27
0012020-01-01ERIN MCLEOD2021-06-15
0012019-01-01ERIN MCLEOD2020-07-21
0012018-01-01ERIN MCLEOD2019-06-12
0012017-01-01ERIN MCLEOD2018-06-12
0012016-01-01ERIN MCLEOD2017-05-25 ERIN MCLEOD2017-05-25
0012015-01-01ERIN MCLEOD2016-07-28
0012014-01-01THOMAS KUNKEL
0012013-01-01THOMAS KUNKEL
0012012-01-01THOMAS KUNKEL
0012011-01-01THOMAS KUNKEL
0012010-01-01THOMAS KUNKEL
0012009-01-01
0012009-01-01THOMAS KUNKEL
0012009-01-01THOMAS KUNKEL SANDEE MFG. COMPANY2010-10-14
0012009-01-01THOMAS KUNKEL THOMAS KUNKEL2010-10-14
0012007-01-01THOMAS KUNKEL

Plan Statistics for SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN

401k plan membership statisitcs for SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN

Measure Date Value
2014: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0156
Total number of active participants reported on line 7a of the Form 55002014-01-0154
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-012
Total of all active and inactive participants2014-01-0156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0156
Number of participants with account balances2014-01-0133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0157
Total number of active participants reported on line 7a of the Form 55002013-01-0154
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-013
Total of all active and inactive participants2013-01-0157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0157
Number of participants with account balances2013-01-0134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0159
Total number of active participants reported on line 7a of the Form 55002012-01-0154
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-013
Total of all active and inactive participants2012-01-0157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0157
Number of participants with account balances2012-01-0154
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0160
Total number of active participants reported on line 7a of the Form 55002011-01-0156
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 participants2011-01-0156
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0156
Number of participants with account balances2011-01-0136
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0166
Total number of active participants reported on line 7a of the Form 55002010-01-0162
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 participants2010-01-0162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0162
Number of participants with account balances2010-01-0137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0163
Total number of active participants reported on line 7a of the Form 55002009-01-0158
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-014
Total of all active and inactive participants2009-01-0162
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0162
Number of participants with account balances2009-01-0140
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010
2007: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-0168
Total number of active participants reported on line 7a of the Form 55002007-01-0164
Number of retired or separated participants receiving benefits2007-01-010
Number of other retired or separated participants entitled to future benefits2007-01-015
Total of all active and inactive participants2007-01-0169
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2007-01-010
Total participants2007-01-0169
Number of participants with account balances2007-01-0141
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2007-01-010

Financial Data on SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN

Measure Date Value
2014 : SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total income from all sources2014-12-31$200,471
Expenses. Total of all expenses incurred2014-12-31$30,092
Benefits paid (including direct rollovers)2014-12-31$27,216
Total plan assets at end of year2014-12-31$1,898,323
Total plan assets at beginning of year2014-12-31$1,727,944
Value of fidelity bond covering the plan2014-12-31$50,000
Total contributions received or receivable from participants2014-12-31$117,812
Expenses. Other expenses not covered elsewhere2014-12-31$1,313
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$82,659
Net income (gross income less expenses)2014-12-31$170,379
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,898,323
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,727,944
Assets. Value of participant loans2014-12-31$27,669
Total contributions received or receivable from employer(s)2014-12-31$0
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$1,563
Funding deficiency by the employer to the plan for this plan year2014-12-31$0
Minimum employer required contribution for this plan year2014-12-31$0
Amount contributed by the employer to the plan for this plan year2014-12-31$0
2013 : SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total income from all sources2013-12-31$389,534
Expenses. Total of all expenses incurred2013-12-31$5,865
Benefits paid (including direct rollovers)2013-12-31$0
Total plan assets at end of year2013-12-31$1,727,944
Total plan assets at beginning of year2013-12-31$1,344,275
Value of fidelity bond covering the plan2013-12-31$50,000
Total contributions received or receivable from participants2013-12-31$101,119
Expenses. Other expenses not covered elsewhere2013-12-31$1,251
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$288,415
Net income (gross income less expenses)2013-12-31$383,669
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,727,944
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,344,275
Assets. Value of participant loans2013-12-31$11,991
Total contributions received or receivable from employer(s)2013-12-31$0
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$4,614
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 : SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total income from all sources2012-12-31$245,110
Expenses. Total of all expenses incurred2012-12-31$58,698
Benefits paid (including direct rollovers)2012-12-31$57,351
Total plan assets at end of year2012-12-31$1,344,275
Total plan assets at beginning of year2012-12-31$1,157,863
Value of fidelity bond covering the plan2012-12-31$50,000
Total contributions received or receivable from participants2012-12-31$111,460
Expenses. Other expenses not covered elsewhere2012-12-31$1,347
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$133,650
Net income (gross income less expenses)2012-12-31$186,412
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,344,275
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,157,863
Assets. Value of participant loans2012-12-31$15,423
Total contributions received or receivable from employer(s)2012-12-31$0
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Funding deficiency by the employer to the plan for this plan year2012-12-31$0
Minimum employer required contribution for this plan year2012-12-31$0
Amount contributed by the employer to the plan for this plan year2012-12-31$0
2011 : SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total income from all sources2011-12-31$64,528
Expenses. Total of all expenses incurred2011-12-31$37,595
Benefits paid (including direct rollovers)2011-12-31$31,017
Total plan assets at end of year2011-12-31$1,157,863
Total plan assets at beginning of year2011-12-31$1,130,930
Value of fidelity bond covering the plan2011-12-31$50,000
Total contributions received or receivable from participants2011-12-31$107,763
Expenses. Other expenses not covered elsewhere2011-12-31$1,380
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-43,235
Net income (gross income less expenses)2011-12-31$26,933
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,157,863
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,130,930
Assets. Value of participant loans2011-12-31$8,185
Total contributions received or receivable from employer(s)2011-12-31$0
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$5,198
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 : SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total income from all sources2010-12-31$178,605
Expenses. Total of all expenses incurred2010-12-31$8,315
Benefits paid (including direct rollovers)2010-12-31$7,099
Total plan assets at end of year2010-12-31$1,130,930
Total plan assets at beginning of year2010-12-31$960,640
Value of fidelity bond covering the plan2010-12-31$50,000
Total contributions received or receivable from participants2010-12-31$90,492
Expenses. Other expenses not covered elsewhere2010-12-31$1,216
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$88,113
Net income (gross income less expenses)2010-12-31$170,290
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,130,930
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$960,640
Assets. Value of participant loans2010-12-31$6,625
Total contributions received or receivable from employer(s)2010-12-31$0
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Funding deficiency by the employer to the plan for this plan year2010-12-31$0
Minimum employer required contribution for this plan year2010-12-31$0
Amount contributed by the employer to the plan for this plan year2010-12-31$0
2009 : SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2009 401k financial data
Funding deficiency by the employer to the plan for this plan year2009-12-31$0
Minimum employer required contribution for this plan year2009-12-31$0
Amount contributed by the employer to the plan for this plan year2009-12-31$0
2008 : SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2008 401k financial data
Transfers to/from the plan2008-12-31$0
Total income from all sources2008-12-31$-203,563
Expenses. Total of all expenses incurred2008-12-31$38,280
Benefits paid (including direct rollovers)2008-12-31$37,338
Total plan assets at end of year2008-12-31$705,723
Total plan assets at beginning of year2008-12-31$947,566
Value of fidelity bond covering the plan2008-12-31$50,000
Total contributions received or receivable from participants2008-12-31$100,063
Expenses. Other expenses not covered elsewhere2008-12-31$942
Contributions received from other sources (not participants or employers)2008-12-31$0
Other income received2008-12-31$-303,626
Net income (gross income less expenses)2008-12-31$-241,843
Net plan assets at end of year (total assets less liabilities)2008-12-31$705,723
Net plan assets at beginning of year (total assets less liabilities)2008-12-31$947,566
Assets. Value of participant loans2008-12-31$396
Total contributions received or receivable from employer(s)2008-12-31$0
Value of certain deemed distributions of participant loans2008-12-31$0
Value of corrective distributions2008-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2008-12-31$0
2007 : SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2007 401k financial data
Transfers to/from the plan2007-12-31$0
Total income from all sources2007-12-31$162,659
Expenses. Total of all expenses incurred2007-12-31$4,450
Benefits paid (including direct rollovers)2007-12-31$2,679
Total plan assets at end of year2007-12-31$947,566
Total plan assets at beginning of year2007-12-31$789,357
Value of fidelity bond covering the plan2007-12-31$50,000
Total contributions received or receivable from participants2007-12-31$99,377
Expenses. Other expenses not covered elsewhere2007-12-31$944
Contributions received from other sources (not participants or employers)2007-12-31$0
Other income received2007-12-31$63,282
Net income (gross income less expenses)2007-12-31$158,209
Net plan assets at end of year (total assets less liabilities)2007-12-31$947,566
Net plan assets at beginning of year (total assets less liabilities)2007-12-31$789,357
Assets. Value of participant loans2007-12-31$802
Total contributions received or receivable from employer(s)2007-12-31$0
Value of certain deemed distributions of participant loans2007-12-31$0
Value of corrective distributions2007-12-31$827

Form 5500 Responses for SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN

2014: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS 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: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS 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: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS 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: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS 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: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
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
2009: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2007: SANDEE MANUFACTURING COMPANY 401(K) SAVINGS PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Submission has been amendedNo
2007-01-01This submission is the final filingNo
2007-01-01This return/report is a short plan year return/report (less than 12 months)No
2007-01-01Plan is a collectively bargained planNo
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan funding arrangement – TrustYes
2007-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-019979
Policy instance 1
Insurance contract or identification numberGA-019979
Number of Individuals Covered33
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,221
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 $5,221
Insurance broker organization code?3
Insurance broker nameUBS FINANCIAL SERVICES
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-019979
Policy instance 1
Insurance contract or identification numberGA-019979
Number of Individuals Covered34
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,304
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 $4,304
Insurance broker organization code?3
Insurance broker nameUBS FINANCIAL SVCS INS AGCY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-019979
Policy instance 1
Insurance contract or identification numberGA-019979
Number of Individuals Covered54
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,093
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 $4,093
Insurance broker organization code?3
Insurance broker nameUBS FINANCIAL SVCS INS AGCY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-019979
Policy instance 1
Insurance contract or identification numberGA-019979
Number of Individuals Covered36
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,833
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-019979
Policy instance 1
Insurance contract or identification numberGA-019979
Number of Individuals Covered37
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,295
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 $3,295
Insurance broker organization code?3
Insurance broker nameUBS FINANCIAL SVCS INS AGCY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-019979
Policy instance 1
Insurance contract or identification numberGA-019979
Number of Individuals Covered40
Insurance policy start date2008-01-01
Insurance policy end date2008-12-31
Total amount of commissions paid to insurance brokerUSD $3,325
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-019979
Policy instance 1
Insurance contract or identification numberGA-019979
Number of Individuals Covered41
Insurance policy start date2007-01-01
Insurance policy end date2007-12-31
Total amount of commissions paid to insurance brokerUSD $3,163
Total amount of fees paid to insurance companyUSD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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