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THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 401k Plan overview

Plan NameTHOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN
Plan identification number 002

THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT 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 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • 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.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

HERBERT J. MEMORIAL HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:HERBERT J. MEMORIAL HOSPITAL
Employer identification number (EIN):550404900
NAIC Classification:622000
NAIC Description: Hospitals

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022014-01-01CHARLIE COVERT2014-08-26
0022013-01-01CHARLIE COVERT2014-07-24
0022012-07-01CHARLIE COVERT
0022012-01-01CHARLIE COVERT
0022011-01-01CHARLIE COVERT
0022010-01-01CHARLIE COVERT
0022009-01-01CHARLIE COVERT

Plan Statistics for THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN

401k plan membership statisitcs for THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN

Measure Date Value
2012: THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01809
Total number of active participants reported on line 7a of the Form 55002012-07-01980
Number of retired or separated participants receiving benefits2012-07-012
Number of other retired or separated participants entitled to future benefits2012-07-0111
Total of all active and inactive participants2012-07-01993
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-010
Total participants2012-07-01993
Number of participants with account balances2012-07-01494
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-07-010
Total participants, beginning-of-year2012-01-011,219
Total number of active participants reported on line 7a of the Form 55002012-01-010
Number of retired or separated participants receiving benefits2012-01-0123
Total of all active and inactive participants2012-01-0123
Total participants2012-01-0123
Number of participants with account balances2012-01-0123
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01988
Total number of active participants reported on line 7a of the Form 55002011-01-01806
Number of retired or separated participants receiving benefits2011-01-0160
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01866
Total participants2011-01-01866
Number of participants with account balances2011-01-01866
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-011,224
Total number of active participants reported on line 7a of the Form 55002010-01-01868
Number of retired or separated participants receiving benefits2010-01-0118
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01886
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01886
Number of participants with account balances2010-01-01886
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-0186
2009: THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-012,309
Total number of active participants reported on line 7a of the Form 55002009-01-01890
Number of retired or separated participants receiving benefits2009-01-0137
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01927
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01927
Number of participants with account balances2009-01-01927
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN

Measure Date Value
2012 : THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$21,210
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$2,732,467
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$10,776
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$146
Value of total corrective distributions2012-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$2,639,292
Value of total assets at end of year2012-12-31$2,742,901
Value of total assets at beginning of year2012-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$10,630
Total interest from all sources2012-12-31$347
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$48,172
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2012-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$48,172
Was this plan covered by a fidelity bond2012-12-31No
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$789,409
Participant contributions at end of year2012-12-31$41,407
Participant contributions at beginning of year2012-12-31$123,485
Participant contributions at end of year2012-12-31$60,311
Participant contributions at beginning of year2012-12-31$48,661
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$1,696,664
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$21,210
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$2,721,691
Value of net assets at end of year (total assets less liabilities)2012-12-31$2,721,691
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$2,629,169
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$13,933,525
Value of interest in pooled separate accounts at beginning of year2012-12-31$1,460,684
Interest on participant loans2012-12-31$347
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$343,351
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$343,351
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$29,270
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-12-31$5,349,056
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$44,656
Net investment gain/loss from pooled separate accounts2012-12-31$185,438
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$153,219
Employer contributions (assets) at end of year2012-12-31$12,014
Employer contributions (assets) at beginning of year2012-12-31$9,409
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$146
Contract administrator fees2012-12-31$10,630
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31SUTTLE & STALNAKER, PLLC
Accountancy firm EIN2012-12-31558723494
2011 : THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 2011 401k financial data
Total income from all sources (including contributions)2011-12-31$1,374,681
Total of all expenses incurred2011-12-31$1,049,463
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$1,025,590
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$1,864,487
Value of total assets at end of year2011-12-31$21,268,171
Value of total assets at beginning of year2011-12-31$20,942,953
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$23,873
Total interest from all sources2011-12-31$111,984
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31No
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$1,415,351
Participant contributions at end of year2011-12-31$123,485
Participant contributions at beginning of year2011-12-31$136,153
Participant contributions at end of year2011-12-31$48,661
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$163,048
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$325,218
Value of net assets at end of year (total assets less liabilities)2011-12-31$21,268,171
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$20,942,953
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$13,933,525
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$13,456,342
Value of interest in pooled separate accounts at end of year2011-12-31$1,460,684
Value of interest in pooled separate accounts at beginning of year2011-12-31$1,703,850
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$343,351
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$276,672
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$276,672
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$111,984
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-12-31$5,349,056
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-12-31$5,369,936
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-606,623
Net investment gain/loss from pooled separate accounts2011-12-31$4,833
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$286,088
Employer contributions (assets) at end of year2011-12-31$9,409
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$1,025,590
Contract administrator fees2011-12-31$23,873
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31SUTTLE AND STALNAKER, PLLC
Accountancy firm EIN2011-12-31558723494
2010 : THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 2010 401k financial data
Total income from all sources (including contributions)2010-12-31$4,060,238
Total of all expenses incurred2010-12-31$953,059
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$904,465
Expenses. Certain deemed distributions of participant loans2010-12-31$31,263
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$2,216,347
Value of total assets at end of year2010-12-31$20,942,953
Value of total assets at beginning of year2010-12-31$17,835,774
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$17,331
Total interest from all sources2010-12-31$63,512
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31No
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$1,418,409
Participant contributions at end of year2010-12-31$136,153
Participant contributions at beginning of year2010-12-31$43,923
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$509,962
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$3,107,179
Value of net assets at end of year (total assets less liabilities)2010-12-31$20,942,953
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$17,835,774
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$13,456,342
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$11,170,017
Value of interest in pooled separate accounts at end of year2010-12-31$1,703,850
Value of interest in pooled separate accounts at beginning of year2010-12-31$1,454,588
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$276,672
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$262,837
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$262,837
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$63,512
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2010-12-31$5,369,936
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2010-12-31$4,904,409
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$1,515,043
Net investment gain/loss from pooled separate accounts2010-12-31$265,336
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$287,976
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$904,465
Contract administrator fees2010-12-31$17,331
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31SUTTLE AND STALNAKER PLLC
Accountancy firm EIN2010-12-31558723494

Form 5500 Responses for THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN

2012: THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)Yes
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: THOMAS MEMORIAL HOSPITAL EMPLOYEES' RETIREMENT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

VARIABLE ANNUITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70238 )
Policy contract number70676
Policy instance 1
Insurance contract or identification number70676
Number of Individuals Covered0
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
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
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-082408
Policy instance 1
Insurance contract or identification numberGA-082408
Number of Individuals Covered0
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,848
Total amount of fees paid to insurance companyUSD $0
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 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 BrokerUSD $4,848
Insurance broker organization code?3
Insurance broker nameG & W EQUITY SALES, INC.
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number82159
Policy instance 2
Insurance contract or identification number82159
Number of Individuals Covered0
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 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
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number075065
Policy instance 3
Insurance contract or identification number075065
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number82159
Policy instance 2
Insurance contract or identification number82159
Number of Individuals Covered4
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-082408
Policy instance 1
Insurance contract or identification numberGA-082408
Number of Individuals Covered108
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,217
Total amount of fees paid to insurance companyUSD $0
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 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
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number075065
Policy instance 3
Insurance contract or identification number075065
Number of Individuals Covered667
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $36,943
Total amount of fees paid to insurance companyUSD $0
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Welfare Benefit Premiums Paid to CarrierUSD $36,943
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 number82159
Policy instance 3
Insurance contract or identification number82159
Number of Individuals Covered4
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-082408
Policy instance 1
Insurance contract or identification numberGA-082408
Number of Individuals Covered115
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 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
Insurance broker organization code?3
Insurance broker nameG & W EQUITY SALES, INC.
AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )
Policy contract number075065
Policy instance 2
Insurance contract or identification number075065
Number of Individuals Covered672
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $32,506
Total amount of fees paid to insurance companyUSD $0
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 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 BrokerUSD $16,705
Insurance broker organization code?3
Insurance broker nameK. SAMPATH

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