401k Plan data: LAX FABRICATING 401(K) PLAN plan

LAX FABRICATING 401(K) PLAN 401k Plan overview

Plan Name	LAX FABRICATING 401(K) PLAN
Plan identification number	001

LAX FABRICATING 401(K) PLAN Benefits

401k Plan Type

Defined 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

LAX FABRICATING, LTD has sponsored the creation of one or more 401k plans.

Company Name: LAX FABRICATING, LTD

Employer identification number (EIN): 412184370

NAIC Classification: 331200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAX FABRICATING 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 JIM JUMBECK 2023-10-03
001 2021-01-01 JIM JUMBECK 2022-10-05
001 2020-01-01 JIM JUMBECK 2021-10-11
001 2019-01-01 JIM JUMBECK 2020-10-12
001 2018-01-01 JIM JUMBECK 2019-10-09
001 2017-01-01 JIM JUMBECK 2018-10-11 JIM JUMBECK 2018-10-11
001 2016-01-01 JIM JUMBECK 2017-07-28 JIM JUMBECK 2017-07-28
001 2015-01-01 JIM JUMBECK 2016-06-08
001 2014-01-01 JIM JUMBECK JIM JUMBECK 2015-06-24
001 2013-01-01 JIM JUMBECK JIM JUMBECK 2014-10-15
001 2012-01-01 JIM JUMBECK
001 2011-01-01 JIM JUMBECK
001 2009-01-01 JIM JUMBECK JIM JUMBECK 2010-07-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	JIM JUMBECK	2023-10-03
001	2021-01-01	JIM JUMBECK	2022-10-05
001	2020-01-01	JIM JUMBECK	2021-10-11
001	2019-01-01	JIM JUMBECK	2020-10-12
001	2018-01-01	JIM JUMBECK	2019-10-09
001	2017-01-01	JIM JUMBECK	2018-10-11	JIM JUMBECK	2018-10-11
001	2016-01-01	JIM JUMBECK	2017-07-28	JIM JUMBECK	2017-07-28
001	2015-01-01	JIM JUMBECK	2016-06-08
001	2014-01-01	JIM JUMBECK		JIM JUMBECK	2015-06-24
001	2013-01-01	JIM JUMBECK		JIM JUMBECK	2014-10-15
001	2012-01-01	JIM JUMBECK
001	2011-01-01	JIM JUMBECK
001	2009-01-01	JIM JUMBECK		JIM JUMBECK	2010-07-14

Plan Statistics for LAX FABRICATING 401(K) PLAN

401k plan membership statisitcs for LAX FABRICATING 401(K) PLAN

Measure Date Value
2014: LAX FABRICATING 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 48
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 40
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 11
Total of all active and inactive participants 2014-01-01 51
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 51
Number of participants with account balances 2014-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: LAX FABRICATING 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 45
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 36
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 11
Total of all active and inactive participants 2013-01-01 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 47
Number of participants with account balances 2013-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: LAX FABRICATING 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 21
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 11
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 11
Total of all active and inactive participants 2012-01-01 22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 22
Number of participants with account balances 2012-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: LAX FABRICATING 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 12
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 14
Total of all active and inactive participants 2011-01-01 26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 26
Number of participants with account balances 2011-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: LAX FABRICATING 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 18
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 33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 33
Number of participants with account balances 2009-01-01 32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 3

Measure	Date	Value
2014: LAX FABRICATING 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	48
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	40
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	11
Total of all active and inactive participants	2014-01-01	51
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	51
Number of participants with account balances	2014-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: LAX FABRICATING 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	45
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	36
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	11
Total of all active and inactive participants	2013-01-01	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	47
Number of participants with account balances	2013-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: LAX FABRICATING 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	21
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	11
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	11
Total of all active and inactive participants	2012-01-01	22
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	22
Number of participants with account balances	2012-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: LAX FABRICATING 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	12
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	14
Total of all active and inactive participants	2011-01-01	26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	26
Number of participants with account balances	2011-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: LAX FABRICATING 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	18
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	33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	33
Number of participants with account balances	2009-01-01	32
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	3

Financial Data on LAX FABRICATING 401(K) PLAN

Measure	Date	Value
2014 : LAX FABRICATING 401(K) PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$0
Total income from all sources	2014-12-31	$52,011
Expenses. Total of all expenses incurred	2014-12-31	$2,196
Benefits paid (including direct rollovers)	2014-12-31	$1,731
Total plan assets at end of year	2014-12-31	$350,672
Total plan assets at beginning of year	2014-12-31	$300,857
Value of fidelity bond covering the plan	2014-12-31	$50,000
Total contributions received or receivable from participants	2014-12-31	$33,262
Expenses. Other expenses not covered elsewhere	2014-12-31	$465
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$18,749
Net income (gross income less expenses)	2014-12-31	$49,815
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$350,672
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$300,857
Assets. Value of participant loans	2014-12-31	$0
Total contributions received or receivable from employer(s)	2014-12-31	$0
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 : LAX FABRICATING 401(K) PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$0
Total income from all sources	2013-12-31	$95,108
Expenses. Total of all expenses incurred	2013-12-31	$460
Benefits paid (including direct rollovers)	2013-12-31	$0
Total plan assets at end of year	2013-12-31	$300,857
Total plan assets at beginning of year	2013-12-31	$206,209
Value of fidelity bond covering the plan	2013-12-31	$50,000
Total contributions received or receivable from participants	2013-12-31	$36,882
Expenses. Other expenses not covered elsewhere	2013-12-31	$460
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$58,226
Net income (gross income less expenses)	2013-12-31	$94,648
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$300,857
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$206,209
Assets. Value of participant loans	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$0
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
2012 : LAX FABRICATING 401(K) PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total income from all sources	2012-12-31	$60,474
Expenses. Total of all expenses incurred	2012-12-31	$36,068
Benefits paid (including direct rollovers)	2012-12-31	$35,598
Total plan assets at end of year	2012-12-31	$206,209
Total plan assets at beginning of year	2012-12-31	$181,803
Value of fidelity bond covering the plan	2012-12-31	$50,000
Total contributions received or receivable from participants	2012-12-31	$36,193
Expenses. Other expenses not covered elsewhere	2012-12-31	$470
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$24,281
Net income (gross income less expenses)	2012-12-31	$24,406
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$206,209
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$181,803
Assets. Value of participant loans	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$0
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 : LAX FABRICATING 401(K) PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total income from all sources	2011-12-31	$7,342
Expenses. Total of all expenses incurred	2011-12-31	$27,760
Benefits paid (including direct rollovers)	2011-12-31	$27,225
Total plan assets at end of year	2011-12-31	$181,803
Total plan assets at beginning of year	2011-12-31	$202,221
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$17,380
Expenses. Other expenses not covered elsewhere	2011-12-31	$535
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-10,038
Net income (gross income less expenses)	2011-12-31	$-20,418
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$181,803
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$202,221
Assets. Value of participant loans	2011-12-31	$0
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 : LAX FABRICATING 401(K) PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total income from all sources	2010-12-31	$36,533
Expenses. Total of all expenses incurred	2010-12-31	$25,968
Benefits paid (including direct rollovers)	2010-12-31	$25,388
Total plan assets at end of year	2010-12-31	$202,221
Total plan assets at beginning of year	2010-12-31	$191,656
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$14,627
Expenses. Other expenses not covered elsewhere	2010-12-31	$580
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$21,906
Net income (gross income less expenses)	2010-12-31	$10,565
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$202,221
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$191,656
Assets. Value of participant loans	2010-12-31	$0
Total contributions received or receivable from employer(s)	2010-12-31	$0
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Funding deficiency by the employer to the plan for this plan year	2010-12-31	$0
Minimum employer required contribution for this plan year	2010-12-31	$0
Amount contributed by the employer to the plan for this plan year	2010-12-31	$0
2009 : LAX FABRICATING 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

Form 5500 Responses for LAX FABRICATING 401(K) PLAN

2014: LAX FABRICATING 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: LAX FABRICATING 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: LAX FABRICATING 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: LAX FABRICATING 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
2009: LAX FABRICATING 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

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-804697

Policy instance

Insurance contract or identification number	GA-804697
Number of Individuals Covered	22
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $1,250
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 $1,250
Insurance broker organization code?	3
Insurance broker name	EDWARD D JONES & CO L P.

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-804697

Policy instance

Insurance contract or identification number	GA-804697
Number of Individuals Covered	22
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $913
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 $913
Insurance broker organization code?	3
Insurance broker name	EDWARD D JONES & CO

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-804697

Policy instance

Insurance contract or identification number	GA-804697
Number of Individuals Covered	26
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $826
Total amount of fees paid to insurance company	USD $207
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-804697

Policy instance

Insurance contract or identification number	GA-804697
Number of Individuals Covered	27
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $711
Total amount of fees paid to insurance company	USD $181
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 $711
Insurance broker organization code?	3
Amount paid for insurance broker fees	181
Additional information about fees paid to insurance broker	SALES/MARKETING
Insurance broker name	EDWARD D JONES & CO

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Company Name:	LAX FABRICATING, LTD
Employer identification number (EIN):	412184370
NAIC Classification:	331200