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INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 401k Plan overview

Plan NameINDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST
Plan identification number 002

INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • 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

INDEPENDENCE PAIN ASSOCIATES has sponsored the creation of one or more 401k plans.

Company Name:INDEPENDENCE PAIN ASSOCIATES
Employer identification number (EIN):450527724
NAIC Classification:541990
NAIC Description:All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022022-01-01
0022021-01-01
0022020-01-01
0022019-01-01
0022018-01-01
0022017-01-01
0022017-01-01
0022016-01-01
0022015-01-01MARIAN CURRAN
0022014-01-01MARIAN CURRAN
0022013-01-01MARIAN CURRAN
0022012-01-01MARIAN CURRAN
0022011-01-01MARIAN CURRAN MARIAN CURRAN2012-05-31
0022010-01-01MARIAN CURRAN

Plan Statistics for INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST

401k plan membership statisitcs for INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2015: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2015 401k membership
Total participants, beginning-of-year2015-01-0117
Total number of active participants reported on line 7a of the Form 55002015-01-0114
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-014
Total of all active and inactive participants2015-01-0118
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0118
Number of participants with account balances2015-01-0118
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2014 401k membership
Total participants, beginning-of-year2014-01-0117
Total number of active participants reported on line 7a of the Form 55002014-01-0113
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 participants2014-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0117
Number of participants with account balances2014-01-0117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-011
2013: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2013 401k membership
Total participants, beginning-of-year2013-01-0116
Total number of active participants reported on line 7a of the Form 55002013-01-0116
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-011
Total of all active and inactive participants2013-01-0117
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0117
Number of participants with account balances2013-01-0117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2012 401k membership
Total participants, beginning-of-year2012-01-0114
Total number of active participants reported on line 7a of the Form 55002012-01-0113
Number of other retired or separated participants entitled to future benefits2012-01-013
Total of all active and inactive participants2012-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0116
Number of participants with account balances2012-01-0115
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2011 401k membership
Total participants, beginning-of-year2011-01-0110
Total number of active participants reported on line 7a of the Form 55002011-01-0114
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 participants2011-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0114
Number of participants with account balances2011-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2010 401k membership
Total participants, beginning-of-year2010-01-0113
Total number of active participants reported on line 7a of the Form 55002010-01-0110
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 participants2010-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0110
Number of participants with account balances2010-01-0110
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010

Financial Data on INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST

Measure Date Value
2015 : INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2015 401k financial data
Total income from all sources2015-12-31$86,870
Expenses. Total of all expenses incurred2015-12-31$17,000
Benefits paid (including direct rollovers)2015-12-31$17,000
Total plan assets at end of year2015-12-31$1,128,635
Total plan assets at beginning of year2015-12-31$1,058,765
Value of fidelity bond covering the plan2015-12-31$250,000
Total contributions received or receivable from participants2015-12-31$61,937
Other income received2015-12-31$3,969
Net income (gross income less expenses)2015-12-31$69,870
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,128,635
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,058,765
Total contributions received or receivable from employer(s)2015-12-31$20,964
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2014 401k financial data
Total income from all sources2014-12-31$143,812
Expenses. Total of all expenses incurred2014-12-31$14,949
Benefits paid (including direct rollovers)2014-12-31$14,949
Total plan assets at end of year2014-12-31$1,058,765
Total plan assets at beginning of year2014-12-31$929,902
Value of fidelity bond covering the plan2014-12-31$250,000
Total contributions received or receivable from participants2014-12-31$70,610
Other income received2014-12-31$45,299
Net income (gross income less expenses)2014-12-31$128,863
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,058,765
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$929,902
Assets. Value of participant loans2014-12-31$3,731
Total contributions received or receivable from employer(s)2014-12-31$27,903
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2013 401k financial data
Total income from all sources2013-12-31$274,629
Expenses. Total of all expenses incurred2013-12-31$337,247
Benefits paid (including direct rollovers)2013-12-31$336,947
Total plan assets at end of year2013-12-31$929,902
Total plan assets at beginning of year2013-12-31$992,520
Value of fidelity bond covering the plan2013-12-31$250,000
Total contributions received or receivable from participants2013-12-31$50,200
Other income received2013-12-31$192,226
Net income (gross income less expenses)2013-12-31$-62,618
Net plan assets at end of year (total assets less liabilities)2013-12-31$929,902
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$992,520
Total contributions received or receivable from employer(s)2013-12-31$32,203
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$300
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2012 401k financial data
Total income from all sources2012-12-31$159,226
Expenses. Total of all expenses incurred2012-12-31$5,719
Benefits paid (including direct rollovers)2012-12-31$5,719
Total plan assets at end of year2012-12-31$992,520
Total plan assets at beginning of year2012-12-31$839,013
Value of fidelity bond covering the plan2012-12-31$250,000
Total contributions received or receivable from participants2012-12-31$55,480
Other income received2012-12-31$78,544
Net income (gross income less expenses)2012-12-31$153,507
Net plan assets at end of year (total assets less liabilities)2012-12-31$992,520
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$839,013
Total contributions received or receivable from employer(s)2012-12-31$25,202
2011 : INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2011 401k financial data
Total income from all sources2011-12-31$98,549
Expenses. Total of all expenses incurred2011-12-31$8,609
Benefits paid (including direct rollovers)2011-12-31$8,584
Total plan assets at end of year2011-12-31$839,013
Total plan assets at beginning of year2011-12-31$749,073
Value of fidelity bond covering the plan2011-12-31$38,547
Total contributions received or receivable from participants2011-12-31$81,979
Other income received2011-12-31$-20,604
Net income (gross income less expenses)2011-12-31$89,940
Net plan assets at end of year (total assets less liabilities)2011-12-31$839,013
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$749,073
Total contributions received or receivable from employer(s)2011-12-31$37,174
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$25
2010 : INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total income from all sources2010-12-31$190,314
Expenses. Total of all expenses incurred2010-12-31$16,940
Benefits paid (including direct rollovers)2010-12-31$16,865
Total plan assets at end of year2010-12-31$749,073
Total plan assets at beginning of year2010-12-31$575,699
Value of fidelity bond covering the plan2010-12-31$38,547
Total contributions received or receivable from participants2010-12-31$60,576
Expenses. Other expenses not covered elsewhere2010-12-31$75
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$45,563
Net income (gross income less expenses)2010-12-31$173,374
Net plan assets at end of year (total assets less liabilities)2010-12-31$749,073
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$575,699
Assets. Value of participant loans2010-12-31$0
Total contributions received or receivable from employer(s)2010-12-31$84,175
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

Form 5500 Responses for INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST

2015: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 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: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 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: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 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: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 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: INDEPENDENCE PAIN ASSOCIATES 401(K) PROFIT SHARING PLAN AND TRUST 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

Insurance Providers Used on plan

VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number873606
Policy instance 1
Insurance contract or identification number873606
Number of Individuals Covered18
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,791
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
Commission paid to Insurance BrokerUSD $2,791
Insurance broker organization code?3
Insurance broker nameBCG SECURITIES INC.
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number873606
Policy instance 1
Insurance contract or identification number873606
Number of Individuals Covered14
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,519
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
Commission paid to Insurance BrokerUSD $2,519
Insurance broker organization code?3
Insurance broker nameBCG SECURITIES INC.
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number873606
Policy instance 1
Insurance contract or identification number873606
Number of Individuals Covered17
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,876
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
Commission paid to Insurance BrokerUSD $2,876
Insurance broker organization code?3
Insurance broker nameBCG SECURITIES INC.
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-814531
Policy instance 1
Insurance contract or identification numberGA-814531
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,652
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
Commission paid to Insurance BrokerUSD $1,277
Insurance broker organization code?3
Insurance broker namePRIMORIS BENEFIT ADVISORS, INC.
VOYA RETIRIEMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 86509 )
Policy contract number873606
Policy instance 2
Insurance contract or identification number873606
Number of Individuals Covered15
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $9,932
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?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
Commission paid to Insurance BrokerUSD $9,932
Insurance broker organization code?3
Insurance broker nameBCG SECURITIES INC.
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-814531
Policy instance 1
Insurance contract or identification numberGA-814531
Number of Individuals Covered14
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,432
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
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-814531
Policy instance 1
Insurance contract or identification numberGA-814531
Number of Individuals Covered10
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $7,199
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 $7,160
Insurance broker organization code?3
Insurance broker nameFN INSURANCE SVSC INC

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