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D3 TECHNOLOGIES 401(K) PLAN 401k Plan overview

Plan NameD3 TECHNOLOGIES 401(K) PLAN
Plan identification number 001

D3 TECHNOLOGIES 401(K) 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.

401k Sponsoring company profile

D3 TECHNOLOGIES has sponsored the creation of one or more 401k plans.

Company Name:D3 TECHNOLOGIES
Employer identification number (EIN):431835341
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan D3 TECHNOLOGIES 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01KEITH NANNEMAN2023-05-23
0012022-01-01KEITH NANNEMAN2024-03-18
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01
0012016-01-01KEITH NANNEMAN2017-06-09
0012015-01-01KEITH NANNEMAN2016-06-15
0012014-01-01KEITH NANNEMAN KEITH NANNEMAN2015-06-26
0012013-01-01KEITH NANNEMAN
0012012-01-01KEITH NANNEMAN
0012011-01-01KEITH NANNEMAN
0012009-01-01CHRIS GARDNER CHRIS GARDNER2010-10-13

Plan Statistics for D3 TECHNOLOGIES 401(K) PLAN

401k plan membership statisitcs for D3 TECHNOLOGIES 401(K) PLAN

Measure Date Value
2022: D3 TECHNOLOGIES 401(K) PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01126
Total number of active participants reported on line 7a of the Form 55002022-01-01117
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0120
Total of all active and inactive participants2022-01-01137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01137
Number of participants with account balances2022-01-01101
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-016
2014: D3 TECHNOLOGIES 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0128
Total number of active participants reported on line 7a of the Form 55002014-01-0126
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-014
Total of all active and inactive participants2014-01-0130
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0130
Number of participants with account balances2014-01-0128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: D3 TECHNOLOGIES 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0121
Total number of active participants reported on line 7a of the Form 55002013-01-0121
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-015
Total of all active and inactive participants2013-01-0126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0126
Number of participants with account balances2013-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-018
2012: D3 TECHNOLOGIES 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0113
Total number of active participants reported on line 7a of the Form 55002012-01-0119
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-011
Total of all active and inactive participants2012-01-0120
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0120
Number of participants with account balances2012-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-014
2011: D3 TECHNOLOGIES 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0113
Total number of active participants reported on line 7a of the Form 55002011-01-0113
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 participants2011-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0113
Number of participants with account balances2011-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2009: D3 TECHNOLOGIES 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0120
Total number of active participants reported on line 7a of the Form 55002009-01-0112
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-017
Total of all active and inactive participants2009-01-0119
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0119
Number of participants with account balances2009-01-0119
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-015

Financial Data on D3 TECHNOLOGIES 401(K) PLAN

Measure Date Value
2022 : D3 TECHNOLOGIES 401(K) PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$41,885
Total income from all sources (including contributions)2022-12-31$203,165
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$304,743
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$298,139
Expenses. Certain deemed distributions of participant loans2022-12-31$4,002
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$940,982
Value of total assets at end of year2022-12-31$3,559,272
Value of total assets at beginning of year2022-12-31$3,702,735
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$2,602
Total interest from all sources2022-12-31$859
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$78,354
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$78,354
Administrative expenses professional fees incurred2022-12-31$660
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$400,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$450,911
Participant contributions at end of year2022-12-31$9,381
Participant contributions at beginning of year2022-12-31$19,669
Participant contributions at end of year2022-12-31$2,158
Participant contributions at beginning of year2022-12-31$2,147
Income. Received or receivable in cash from other sources (including rollovers)2022-12-31$267,590
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$41,885
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-101,578
Value of net assets at end of year (total assets less liabilities)2022-12-31$3,559,272
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$3,660,850
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$3,540,623
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$3,680,161
Interest on participant loans2022-12-31$859
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-817,030
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$222,481
Employer contributions (assets) at end of year2022-12-31$7,110
Employer contributions (assets) at beginning of year2022-12-31$758
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$298,139
Contract administrator fees2022-12-31$2,602
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31FORVIS,LLP
Accountancy firm EIN2022-12-31440160260
2014 : D3 TECHNOLOGIES 401(K) PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$2
Total income from all sources2014-12-31$128,780
Expenses. Total of all expenses incurred2014-12-31$6,430
Benefits paid (including direct rollovers)2014-12-31$5,915
Total plan assets at end of year2014-12-31$539,929
Total plan assets at beginning of year2014-12-31$417,577
Value of fidelity bond covering the plan2014-12-31$25,000
Total contributions received or receivable from participants2014-12-31$79,844
Expenses. Other expenses not covered elsewhere2014-12-31$515
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$17,078
Net income (gross income less expenses)2014-12-31$122,350
Net plan assets at end of year (total assets less liabilities)2014-12-31$539,929
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$417,577
Assets. Value of participant loans2014-12-31$0
Total contributions received or receivable from employer(s)2014-12-31$31,858
Value of certain deemed distributions of participant loans2014-12-31$0
Value of corrective distributions2014-12-31$0
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 : D3 TECHNOLOGIES 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$284
Total income from all sources2013-12-31$182,303
Expenses. Total of all expenses incurred2013-12-31$729
Benefits paid (including direct rollovers)2013-12-31$0
Total plan assets at end of year2013-12-31$417,577
Total plan assets at beginning of year2013-12-31$235,719
Value of fidelity bond covering the plan2013-12-31$25,000
Total contributions received or receivable from participants2013-12-31$62,508
Expenses. Other expenses not covered elsewhere2013-12-31$445
Contributions received from other sources (not participants or employers)2013-12-31$16,436
Other income received2013-12-31$75,197
Net income (gross income less expenses)2013-12-31$181,574
Net plan assets at end of year (total assets less liabilities)2013-12-31$417,577
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$235,719
Assets. Value of participant loans2013-12-31$0
Total contributions received or receivable from employer(s)2013-12-31$28,162
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$284
2012 : D3 TECHNOLOGIES 401(K) PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total income from all sources2012-12-31$97,973
Expenses. Total of all expenses incurred2012-12-31$5,969
Benefits paid (including direct rollovers)2012-12-31$5,475
Total plan assets at end of year2012-12-31$235,719
Total plan assets at beginning of year2012-12-31$143,715
Value of fidelity bond covering the plan2012-12-31$25,000
Total contributions received or receivable from participants2012-12-31$51,628
Expenses. Other expenses not covered elsewhere2012-12-31$325
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$28,346
Net income (gross income less expenses)2012-12-31$92,004
Net plan assets at end of year (total assets less liabilities)2012-12-31$235,719
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$143,715
Assets. Value of participant loans2012-12-31$0
Total contributions received or receivable from employer(s)2012-12-31$17,999
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$169
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 : D3 TECHNOLOGIES 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total income from all sources2011-12-31$40,726
Expenses. Total of all expenses incurred2011-12-31$15,420
Benefits paid (including direct rollovers)2011-12-31$15,135
Total plan assets at end of year2011-12-31$143,715
Total plan assets at beginning of year2011-12-31$118,409
Value of fidelity bond covering the plan2011-12-31$10,000
Total contributions received or receivable from participants2011-12-31$45,030
Expenses. Other expenses not covered elsewhere2011-12-31$285
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-21,823
Net income (gross income less expenses)2011-12-31$25,306
Net plan assets at end of year (total assets less liabilities)2011-12-31$143,715
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$118,409
Assets. Value of participant loans2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$17,519
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
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 : D3 TECHNOLOGIES 401(K) PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total income from all sources2010-12-31$47,622
Expenses. Total of all expenses incurred2010-12-31$33,681
Benefits paid (including direct rollovers)2010-12-31$33,371
Total plan assets at end of year2010-12-31$118,409
Total plan assets at beginning of year2010-12-31$104,468
Value of fidelity bond covering the plan2010-12-31$10,000
Total contributions received or receivable from participants2010-12-31$20,704
Expenses. Other expenses not covered elsewhere2010-12-31$310
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$11,857
Net income (gross income less expenses)2010-12-31$13,941
Net plan assets at end of year (total assets less liabilities)2010-12-31$118,409
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$104,468
Assets. Value of participant loans2010-12-31$0
Total contributions received or receivable from employer(s)2010-12-31$15,061
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 : D3 TECHNOLOGIES 401(K) 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

Form 5500 Responses for D3 TECHNOLOGIES 401(K) PLAN

2022: D3 TECHNOLOGIES 401(K) PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2014: D3 TECHNOLOGIES 401(K) 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: D3 TECHNOLOGIES 401(K) 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: D3 TECHNOLOGIES 401(K) 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: D3 TECHNOLOGIES 401(K) 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
2009: D3 TECHNOLOGIES 401(K) 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

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-809420
Policy instance 1
Insurance contract or identification numberGA-809420
Number of Individuals Covered0
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $7,241
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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?No
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 $7,241
Insurance broker organization code?3
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-809420
Policy instance 1
Insurance contract or identification numberGA-809420
Number of Individuals Covered28
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,091
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 $2,091
Insurance broker organization code?3
Insurance broker nameJHW FINANCIAL SERVICES INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-809420
Policy instance 1
Insurance contract or identification numberGA-809420
Number of Individuals Covered23
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,880
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 $1,880
Insurance broker organization code?3
Insurance broker nameJHW FINANCIAL SERVICES INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-809420
Policy instance 1
Insurance contract or identification numberGA-809420
Number of Individuals Covered19
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,248
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 $1,248
Insurance broker organization code?3
Insurance broker nameJHW FINANCIAL SERVICES INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-809420
Policy instance 1
Insurance contract or identification numberGA-809420
Number of Individuals Covered11
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,059
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-809420
Policy instance 1
Insurance contract or identification numberGA-809420
Number of Individuals Covered14
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $635
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

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