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CHILDREN AT PLAY 401(K) PLAN 401k Plan overview

Plan NameCHILDREN AT PLAY 401(K) PLAN
Plan identification number 002

CHILDREN AT PLAY 401(K) PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
  • 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.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • 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

CHILDREN AT PLAY has sponsored the creation of one or more 401k plans.

Company Name:CHILDREN AT PLAY
Employer identification number (EIN):550868334
NAIC Classification:611000

Additional information about CHILDREN AT PLAY

Jurisdiction of Incorporation: Washington Secretary of State Corporations Division
Incorporation Date: 2001-10-08
Company Identification Number: 602153893
Legal Registered Office Address: 711 CAPITOL WAY S SUITE 204

OLYMPIA
United States of America (USA)
98501

More information about CHILDREN AT PLAY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHILDREN AT PLAY 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0022021-07-01KAREN BRYANT2023-04-18 KAREN BRYANT2023-04-18
0022020-07-01KAREN BRYANT2022-04-18 KAREN BRYANT2022-04-18
0022019-07-01LINDA SALMON2021-04-13 LINDA SALMON2021-04-13
0022018-07-01
0022017-07-01LINDA SALMON2019-04-15 LINDA SALMON2019-04-15
0022017-07-01LINDA SALMON2019-04-15 LINDA SALMON2019-04-15
0022017-07-01LINDA SALMON2021-04-13 LINDA SALMON2021-04-13
0022016-07-01LINDA SALMON2018-01-16
0022015-07-01
0022014-07-01
0022014-07-01
0022013-07-01LINDA SALMON
0022012-07-01LINDA SALMON
0022011-07-01LINDA SALMON
0022010-07-01LINDA SALMON
0022009-07-01LINDA SALMON

Plan Statistics for CHILDREN AT PLAY 401(K) PLAN

401k plan membership statisitcs for CHILDREN AT PLAY 401(K) PLAN

Measure Date Value
2018: CHILDREN AT PLAY 401(K) PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01163
Total number of active participants reported on line 7a of the Form 55002018-07-01142
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-0122
Total of all active and inactive participants2018-07-01164
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-07-011
Total participants2018-07-01165
Number of participants with account balances2018-07-0174
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-07-011
2013: CHILDREN AT PLAY 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-0173
Total number of active participants reported on line 7a of the Form 55002013-07-0149
Number of retired or separated participants receiving benefits2013-07-010
Number of other retired or separated participants entitled to future benefits2013-07-0124
Total of all active and inactive participants2013-07-0173
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-07-011
Total participants2013-07-0174
Number of participants with account balances2013-07-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-07-012
2012: CHILDREN AT PLAY 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-0167
Total number of active participants reported on line 7a of the Form 55002012-07-0159
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-0122
Total of all active and inactive participants2012-07-0181
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-011
Total participants2012-07-0182
Number of participants with account balances2012-07-0160
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-07-0121
2011: CHILDREN AT PLAY 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-0162
Total number of active participants reported on line 7a of the Form 55002011-07-0141
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-0120
Total of all active and inactive participants2011-07-0161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-07-011
Total participants2011-07-0162
Number of participants with account balances2011-07-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-07-0121
2010: CHILDREN AT PLAY 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-07-0156
Total number of active participants reported on line 7a of the Form 55002010-07-0139
Number of retired or separated participants receiving benefits2010-07-010
Number of other retired or separated participants entitled to future benefits2010-07-016
Total of all active and inactive participants2010-07-0145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-07-010
Total participants2010-07-0145
Number of participants with account balances2010-07-0145
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-07-010
2009: CHILDREN AT PLAY 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-0153
Total number of active participants reported on line 7a of the Form 55002009-07-0137
Number of retired or separated participants receiving benefits2009-07-010
Number of other retired or separated participants entitled to future benefits2009-07-0113
Total of all active and inactive participants2009-07-0150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-07-010
Total participants2009-07-0150
Number of participants with account balances2009-07-0142
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-07-010

Financial Data on CHILDREN AT PLAY 401(K) PLAN

Measure Date Value
2019 : CHILDREN AT PLAY 401(K) PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total income from all sources (including contributions)2019-06-30$251,874
Total loss/gain on sale of assets2019-06-30$0
Total of all expenses incurred2019-06-30$21,451
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$20,804
Expenses. Certain deemed distributions of participant loans2019-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$87,394
Value of total assets at end of year2019-06-30$3,545,743
Value of total assets at beginning of year2019-06-30$3,315,320
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$647
Total interest from all sources2019-06-30$2,356
Total dividends received (eg from common stock, registered investment company shares)2019-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30No
Was this plan covered by a fidelity bond2019-06-30No
If this is an individual account plan, was there a blackout period2019-06-30No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-06-30$0
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Contributions received from participants2019-06-30$87,394
Income. Received or receivable in cash from other sources (including rollovers)2019-06-30$0
Other income not declared elsewhere2019-06-30$0
Administrative expenses (other) incurred2019-06-30$647
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Value of net income/loss2019-06-30$230,423
Value of net assets at end of year (total assets less liabilities)2019-06-30$3,545,743
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$3,315,320
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-06-30$3,334,668
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-06-30$3,232,542
Interest on participant loans2019-06-30$0
Interest earned on other investments2019-06-30$2,356
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-06-30$211,075
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-06-30$82,778
Expenses. Payments to insurance carriers foe the provision of benefits2019-06-30$0
Net investment gain/loss from pooled separate accounts2019-06-30$162,124
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30No
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-06-30$20,804
Did the plan have assets held for investment2019-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-06-30No
Opinion of an independent qualified public accountant for this plan2019-06-30Disclaimer
2014 : CHILDREN AT PLAY 401(K) PLAN 2014 401k financial data
Transfers to/from the plan2014-06-30$0
Total income from all sources2014-06-30$532,116
Expenses. Total of all expenses incurred2014-06-30$49,097
Benefits paid (including direct rollovers)2014-06-30$49,049
Total plan assets at end of year2014-06-30$2,807,698
Total plan assets at beginning of year2014-06-30$2,324,679
Value of fidelity bond covering the plan2014-06-30$265,000
Total contributions received or receivable from participants2014-06-30$77,587
Expenses. Other expenses not covered elsewhere2014-06-30$48
Contributions received from other sources (not participants or employers)2014-06-30$0
Other income received2014-06-30$429,529
Net income (gross income less expenses)2014-06-30$483,019
Net plan assets at end of year (total assets less liabilities)2014-06-30$2,807,698
Net plan assets at beginning of year (total assets less liabilities)2014-06-30$2,324,679
Assets. Value of participant loans2014-06-30$15,713
Total contributions received or receivable from employer(s)2014-06-30$25,000
Value of certain deemed distributions of participant loans2014-06-30$0
Value of corrective distributions2014-06-30$0
Funding deficiency by the employer to the plan for this plan year2014-06-30$0
Minimum employer required contribution for this plan year2014-06-30$0
Amount contributed by the employer to the plan for this plan year2014-06-30$0
2013 : CHILDREN AT PLAY 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-06-30$0
Total income from all sources2013-06-30$400,513
Expenses. Total of all expenses incurred2013-06-30$48
Benefits paid (including direct rollovers)2013-06-30$0
Total plan assets at end of year2013-06-30$2,324,679
Total plan assets at beginning of year2013-06-30$1,924,214
Value of fidelity bond covering the plan2013-06-30$265,000
Total contributions received or receivable from participants2013-06-30$72,626
Expenses. Other expenses not covered elsewhere2013-06-30$48
Contributions received from other sources (not participants or employers)2013-06-30$0
Other income received2013-06-30$297,887
Net income (gross income less expenses)2013-06-30$400,465
Net plan assets at end of year (total assets less liabilities)2013-06-30$2,324,679
Net plan assets at beginning of year (total assets less liabilities)2013-06-30$1,924,214
Assets. Value of participant loans2013-06-30$29,921
Total contributions received or receivable from employer(s)2013-06-30$30,000
Value of certain deemed distributions of participant loans2013-06-30$0
Value of corrective distributions2013-06-30$0
2012 : CHILDREN AT PLAY 401(K) PLAN 2012 401k financial data
Transfers to/from the plan2012-06-30$0
Total income from all sources2012-06-30$142,195
Expenses. Total of all expenses incurred2012-06-30$176,378
Benefits paid (including direct rollovers)2012-06-30$176,330
Total plan assets at end of year2012-06-30$1,924,214
Total plan assets at beginning of year2012-06-30$1,958,397
Value of fidelity bond covering the plan2012-06-30$265,000
Total contributions received or receivable from participants2012-06-30$90,741
Expenses. Other expenses not covered elsewhere2012-06-30$48
Contributions received from other sources (not participants or employers)2012-06-30$0
Other income received2012-06-30$-6,546
Net income (gross income less expenses)2012-06-30$-34,183
Net plan assets at end of year (total assets less liabilities)2012-06-30$1,924,214
Net plan assets at beginning of year (total assets less liabilities)2012-06-30$1,958,397
Assets. Value of participant loans2012-06-30$43,676
Total contributions received or receivable from employer(s)2012-06-30$58,000
Value of certain deemed distributions of participant loans2012-06-30$0
Value of corrective distributions2012-06-30$0
Funding deficiency by the employer to the plan for this plan year2012-06-30$0
Minimum employer required contribution for this plan year2012-06-30$0
Amount contributed by the employer to the plan for this plan year2012-06-30$0
2011 : CHILDREN AT PLAY 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-06-30$0
Total income from all sources2011-06-30$440,158
Expenses. Total of all expenses incurred2011-06-30$375
Benefits paid (including direct rollovers)2011-06-30$227
Total plan assets at end of year2011-06-30$1,958,397
Total plan assets at beginning of year2011-06-30$1,518,614
Value of fidelity bond covering the plan2011-06-30$265,000
Total contributions received or receivable from participants2011-06-30$100,338
Expenses. Other expenses not covered elsewhere2011-06-30$148
Contributions received from other sources (not participants or employers)2011-06-30$0
Other income received2011-06-30$299,820
Net income (gross income less expenses)2011-06-30$439,783
Net plan assets at end of year (total assets less liabilities)2011-06-30$1,958,397
Net plan assets at beginning of year (total assets less liabilities)2011-06-30$1,518,614
Assets. Value of participant loans2011-06-30$56,991
Total contributions received or receivable from employer(s)2011-06-30$40,000
Value of certain deemed distributions of participant loans2011-06-30$0
Value of corrective distributions2011-06-30$0
Funding deficiency by the employer to the plan for this plan year2011-06-30$0
Minimum employer required contribution for this plan year2011-06-30$0
Amount contributed by the employer to the plan for this plan year2011-06-30$0
2010 : CHILDREN AT PLAY 401(K) PLAN 2010 401k financial data
Funding deficiency by the employer to the plan for this plan year2010-06-30$0
Minimum employer required contribution for this plan year2010-06-30$0
Amount contributed by the employer to the plan for this plan year2010-06-30$0

Form 5500 Responses for CHILDREN AT PLAY 401(K) PLAN

2018: CHILDREN AT PLAY 401(K) PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2013: CHILDREN AT PLAY 401(K) PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: CHILDREN AT PLAY 401(K) 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)No
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
2011: CHILDREN AT PLAY 401(K) PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: CHILDREN AT PLAY 401(K) PLAN 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan funding arrangement – TrustYes
2010-07-01Plan benefit arrangement – InsuranceYes
2009: CHILDREN AT PLAY 401(K) PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number089078I
Policy instance 1
Insurance contract or identification number089078I
Number of Individuals Covered165
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $12,473
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 Administration1
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 $0
Amount paid for insurance broker fees12473
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-017093
Policy instance 1
Insurance contract or identification numberGA-017093
Number of Individuals Covered45
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $6,134
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 $6,134
Insurance broker organization code?3
Insurance broker nameE B COHEN & CO INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-017093
Policy instance 1
Insurance contract or identification numberGA-017093
Number of Individuals Covered60
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $4,963
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 $4,963
Insurance broker organization code?3
Insurance broker nameE B COHEN & CO INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-017093
Policy instance 1
Insurance contract or identification numberGA-017093
Number of Individuals Covered42
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $4,642
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-017093
Policy instance 1
Insurance contract or identification numberGA-017093
Number of Individuals Covered45
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $4,139
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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