BERGMAN ACADEMY has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2019: POOLED SEPARATE ACCOUNT 48 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 56 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 60 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 60 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2019-01-01 | 0 |
| Total participants | 2019-01-01 | 60 |
| Number of participants with account balances | 2019-01-01 | 60 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2019-01-01 | 0 |
| 2018: POOLED SEPARATE ACCOUNT 48 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 49 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 56 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 56 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-01-01 | 0 |
| Total participants | 2018-01-01 | 56 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-01-01 | 0 |
| 2017: POOLED SEPARATE ACCOUNT 48 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 40 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 49 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 49 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-01-01 | 0 |
| Total participants | 2017-01-01 | 49 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-01-01 | 0 |
| 2016: POOLED SEPARATE ACCOUNT 48 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 40 |
| Total of all active and inactive participants | 2016-01-01 | 40 |
| Total participants | 2016-01-01 | 40 |
| 2015: POOLED SEPARATE ACCOUNT 48 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 35 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 39 |
| Total of all active and inactive participants | 2015-01-01 | 39 |
| Total participants | 2015-01-01 | 39 |
| 2014: POOLED SEPARATE ACCOUNT 48 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 31 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 35 |
| Total of all active and inactive participants | 2014-01-01 | 35 |
| Total participants | 2014-01-01 | 35 |
| 2013: POOLED SEPARATE ACCOUNT 48 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 33 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 31 |
| Total of all active and inactive participants | 2013-01-01 | 31 |
| Total participants | 2013-01-01 | 31 |
| 2012: POOLED SEPARATE ACCOUNT 48 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 30 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 33 |
| Total of all active and inactive participants | 2012-01-01 | 33 |
| Total participants | 2012-01-01 | 33 |
| 2011: POOLED SEPARATE ACCOUNT 48 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 24 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 30 |
| Total of all active and inactive participants | 2011-01-01 | 30 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-01-01 | 0 |
| Total participants | 2011-01-01 | 30 |
| Measure | Date | Value |
|---|
| 2019 : POOLED SEPARATE ACCOUNT 48 2019 401k financial data |
|---|
| Transfers to/from the plan | 2019-12-31 | $-157,491 |
| Total plan liabilities at beginning of year | 2019-12-31 | $148 |
| Total income from all sources | 2019-12-31 | $246,167 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $16,566 |
| Total plan assets at end of year | 2019-12-31 | $862,859 |
| Total plan assets at beginning of year | 2019-12-31 | $790,897 |
| Total contributions received or receivable from participants | 2019-12-31 | $35,290 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $1 |
| Contributions received from other sources (not participants or employers) | 2019-12-31 | $6,604 |
| Other income received | 2019-12-31 | $133,899 |
| Net income (gross income less expenses) | 2019-12-31 | $229,601 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $862,859 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $790,749 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $70,374 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $16,565 |
| 2018 : POOLED SEPARATE ACCOUNT 48 2018 401k financial data |
|---|
| Transfers to/from the plan | 2018-12-31 | $3,226 |
| Total plan liabilities at end of year | 2018-12-31 | $148 |
| Total plan liabilities at beginning of year | 2018-12-31 | $722 |
| Total income from all sources | 2018-12-31 | $64,704 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $13,498 |
| Total plan assets at end of year | 2018-12-31 | $790,897 |
| Total plan assets at beginning of year | 2018-12-31 | $737,039 |
| Total contributions received or receivable from participants | 2018-12-31 | $39,401 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $10 |
| Contributions received from other sources (not participants or employers) | 2018-12-31 | $6,535 |
| Other income received | 2018-12-31 | $-48,015 |
| Net income (gross income less expenses) | 2018-12-31 | $51,206 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $790,749 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $736,317 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $66,783 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $13,488 |
| 2017 : POOLED SEPARATE ACCOUNT 48 2017 401k financial data |
|---|
| Transfers to/from the plan | 2017-12-31 | $8,535 |
| Total plan liabilities at end of year | 2017-12-31 | $722 |
| Total plan liabilities at beginning of year | 2017-12-31 | $18,880 |
| Total income from all sources | 2017-12-31 | $177,232 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $13,886 |
| Total plan assets at end of year | 2017-12-31 | $737,039 |
| Total plan assets at beginning of year | 2017-12-31 | $583,316 |
| Total contributions received or receivable from participants | 2017-12-31 | $38,506 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $567 |
| Contributions received from other sources (not participants or employers) | 2017-12-31 | $6,432 |
| Other income received | 2017-12-31 | $77,672 |
| Net income (gross income less expenses) | 2017-12-31 | $163,346 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $736,317 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $564,436 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $54,622 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $13,319 |
| 2016 : POOLED SEPARATE ACCOUNT 48 2016 401k financial data |
|---|
| Transfers to/from the plan | 2016-12-31 | $-45,881 |
| Total plan liabilities at end of year | 2016-12-31 | $18,880 |
| Total income from all sources | 2016-12-31 | $168,264 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $325,229 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $314,488 |
| Total plan assets at end of year | 2016-12-31 | $583,316 |
| Total plan assets at beginning of year | 2016-12-31 | $767,282 |
| Total contributions received or receivable from participants | 2016-12-31 | $38,167 |
| Contributions received from other sources (not participants or employers) | 2016-12-31 | $23,065 |
| Other income received | 2016-12-31 | $40,848 |
| Net income (gross income less expenses) | 2016-12-31 | $-156,965 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $564,436 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $767,282 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $66,184 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $10,741 |
| 2015 : POOLED SEPARATE ACCOUNT 48 2015 401k financial data |
|---|
| Transfers to/from the plan | 2015-12-31 | $-3,723 |
| Total income from all sources | 2015-12-31 | $119,083 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $8,478 |
| Total plan assets at end of year | 2015-12-31 | $767,282 |
| Total plan assets at beginning of year | 2015-12-31 | $660,400 |
| Total contributions received or receivable from participants | 2015-12-31 | $39,175 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $81 |
| Contributions received from other sources (not participants or employers) | 2015-12-31 | $12,269 |
| Other income received | 2015-12-31 | $15,412 |
| Net income (gross income less expenses) | 2015-12-31 | $110,605 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $767,282 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $660,400 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $52,227 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $8,397 |
| 2014 : POOLED SEPARATE ACCOUNT 48 2014 401k financial data |
|---|
| Transfers to/from the plan | 2014-12-31 | $-9,859 |
| Total plan liabilities at beginning of year | 2014-12-31 | $5,902 |
| Total income from all sources | 2014-12-31 | $113,461 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $9,084 |
| Total plan assets at end of year | 2014-12-31 | $660,400 |
| Total plan assets at beginning of year | 2014-12-31 | $571,784 |
| Total contributions received or receivable from participants | 2014-12-31 | $25,168 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $100 |
| Contributions received from other sources (not participants or employers) | 2014-12-31 | $10,836 |
| Other income received | 2014-12-31 | $35,431 |
| Net income (gross income less expenses) | 2014-12-31 | $104,377 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $660,400 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $565,882 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $42,026 |
| Value of certain deemed distributions of participant loans | 2014-12-31 | $2,064 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $6,920 |
| 2013 : POOLED SEPARATE ACCOUNT 48 2013 401k financial data |
|---|
| Transfers to/from the plan | 2013-12-31 | $-85,197 |
| Total plan liabilities at end of year | 2013-12-31 | $5,902 |
| Total plan liabilities at beginning of year | 2013-12-31 | $513 |
| Total income from all sources | 2013-12-31 | $116,956 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $7,234 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $498 |
| Total plan assets at end of year | 2013-12-31 | $571,784 |
| Total plan assets at beginning of year | 2013-12-31 | $541,870 |
| Total contributions received or receivable from participants | 2013-12-31 | $9,712 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $832 |
| Contributions received from other sources (not participants or employers) | 2013-12-31 | $7,340 |
| Other income received | 2013-12-31 | $63,577 |
| Net income (gross income less expenses) | 2013-12-31 | $109,722 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $565,882 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $541,357 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $36,327 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $5,904 |
| 2012 : POOLED SEPARATE ACCOUNT 48 2012 401k financial data |
|---|
| Transfers to/from the plan | 2012-12-31 | $-13,608 |
| Total plan liabilities at end of year | 2012-12-31 | $513 |
| Total plan liabilities at beginning of year | 2012-12-31 | $498 |
| Total income from all sources | 2012-12-31 | $57,246 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $5,350 |
| Total plan assets at end of year | 2012-12-31 | $541,870 |
| Total plan assets at beginning of year | 2012-12-31 | $484,825 |
| Total contributions received or receivable from participants | 2012-12-31 | $6,531 |
| Contributions received from other sources (not participants or employers) | 2012-12-31 | $7,172 |
| Other income received | 2012-12-31 | $9,581 |
| Net income (gross income less expenses) | 2012-12-31 | $51,896 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $541,357 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $484,327 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $33,962 |
| Value of certain deemed distributions of participant loans | 2012-12-31 | $513 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $4,837 |
| 2011 : POOLED SEPARATE ACCOUNT 48 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-12-31 | $498 |
| Total plan liabilities at beginning of year | 2011-12-31 | $0 |
| Total income from all sources | 2011-12-31 | $115,596 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $3,813 |
| Total plan assets at end of year | 2011-12-31 | $484,825 |
| Total plan assets at beginning of year | 2011-12-31 | $464,145 |
| Total contributions received or receivable from participants | 2011-12-31 | $8,915 |
| Assets. Value of loans (other than to participants) | 2011-12-31 | $55 |
| Contributions received from other sources (not participants or employers) | 2011-12-31 | $13,978 |
| Other income received | 2011-12-31 | $63,295 |
| Net income (gross income less expenses) | 2011-12-31 | $111,783 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $484,327 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $464,145 |
| Assets. Value of participant loans | 2011-12-31 | $498 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $29,408 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-12-31 | $3,813 |
| 2019: POOLED SEPARATE ACCOUNT 48 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: POOLED SEPARATE ACCOUNT 48 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: POOLED SEPARATE ACCOUNT 48 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: POOLED SEPARATE ACCOUNT 48 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: POOLED SEPARATE ACCOUNT 48 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: POOLED SEPARATE ACCOUNT 48 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 benefit arrangement – Insurance | Yes |
| 2013: POOLED SEPARATE ACCOUNT 48 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: POOLED SEPARATE ACCOUNT 48 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | First time form 5500 has been submitted | Yes |
| 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 benefit arrangement – Insurance | Yes |
| 2011: POOLED SEPARATE ACCOUNT 48 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | First time form 5500 has been submitted | Yes |
| 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 benefit arrangement – Insurance | Yes |
| AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 ) |
| Policy contract number | 748396001 |
| Policy instance | 1 |
| Insurance contract or identification number | 748396001 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,502 | | 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 | | Commission paid to Insurance Broker | USD $3,140 | | Insurance broker organization code? | 3 |
|
| AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 ) |
| Policy contract number | 748396001 |
| Policy instance | 1 |
| Insurance contract or identification number | 748396001 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,025 | | 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 | | Commission paid to Insurance Broker | USD $2,955 | | Insurance broker organization code? | 3 |
|
| AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 ) |
| Policy contract number | 748396001 |
| Policy instance | 1 |
| Insurance contract or identification number | 748396001 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,559 | | 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 | | Commission paid to Insurance Broker | USD $3,489 | | Insurance broker organization code? | 3 | | Insurance broker name | AXA NETWORK LLC |
|
| AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 ) |
| Policy contract number | 748396 001 |
| Policy instance | 1 |
| Insurance contract or identification number | 748396 001 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $614 | | 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 $7 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 | | Insurance broker name | R. VAN HORN |
|
| AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 ) |
| Policy contract number | 748396 001 |
| Policy instance | 1 |
| Insurance contract or identification number | 748396 001 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,244 | | 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 $81 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 0 | | Insurance broker name | R VAN HORN |
|
| AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 ) |
| Policy contract number | 748396 001 |
| Policy instance | 1 |
| Insurance contract or identification number | 748396 001 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,081 | | Total amount of fees paid to insurance company | USD $0 | | 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 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 | | Commission paid to Insurance Broker | USD $997 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 | | Insurance broker name | T. SMTIH, CLU |
|
| AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 ) |
| Policy contract number | 748396 001 |
| Policy instance | 1 |
| Insurance contract or identification number | 748396 001 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,175 | | Total amount of fees paid to insurance company | USD $3,981 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Commission paid to Insurance Broker | USD $1,079 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | NA | | Insurance broker organization code? | 3 | | Insurance broker name | G AXA NETWORK LLC |
|
| AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 ) |
| Policy contract number | 748396 001 |
| Policy instance | 1 |
| Insurance contract or identification number | 748396 001 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,153 | | Total amount of fees paid to insurance company | USD $3,121 | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes |
|
