KINSTON PEDIATRIC ASSOCIATES, P.A. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN
401k plan membership statisitcs for KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN
| Measure | Date | Value |
|---|
| 2017: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 31 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 34 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 34 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-01-01 | 0 |
| Total participants | 2017-01-01 | 34 |
| Number of participants with account balances | 2017-01-01 | 37 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2017-01-01 | 0 |
| 2016: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 33 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 31 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 31 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-01-01 | 0 |
| Total participants | 2016-01-01 | 31 |
| Number of participants with account balances | 2016-01-01 | 37 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-01-01 | 0 |
| 2015: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 38 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 33 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 33 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2015-01-01 | 0 |
| Total participants | 2015-01-01 | 33 |
| Number of participants with account balances | 2015-01-01 | 38 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2015-01-01 | 0 |
| 2012: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 35 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 33 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 4 |
| Total of all active and inactive participants | 2012-01-01 | 37 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 0 |
| Total participants | 2012-01-01 | 37 |
| Number of participants with account balances | 2012-01-01 | 35 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-01-01 | 0 |
| 2011: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-05-01 | 29 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 29 |
| Number of retired or separated participants receiving benefits | 2011-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-05-01 | 0 |
| Total of all active and inactive participants | 2011-05-01 | 29 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-05-01 | 0 |
| Total participants | 2011-05-01 | 29 |
| Number of participants with account balances | 2011-05-01 | 29 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-05-01 | 0 |
| 2010: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-05-01 | 28 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-05-01 | 27 |
| Number of retired or separated participants receiving benefits | 2010-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-05-01 | 1 |
| Total of all active and inactive participants | 2010-05-01 | 28 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-05-01 | 0 |
| Total participants | 2010-05-01 | 28 |
| Number of participants with account balances | 2010-05-01 | 28 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-05-01 | 0 |
| 2009: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-05-01 | 29 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 27 |
| Number of retired or separated participants receiving benefits | 2009-05-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-05-01 | 3 |
| Total of all active and inactive participants | 2009-05-01 | 30 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-05-01 | 0 |
| Total participants | 2009-05-01 | 30 |
| Number of participants with account balances | 2009-05-01 | 30 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-05-01 | 0 |
| Measure | Date | Value |
|---|
| 2017 : KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2017 401k financial data |
|---|
| Total income from all sources | 2017-12-31 | $425,276 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $14,014 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $13,889 |
| Total plan assets at end of year | 2017-12-31 | $2,630,167 |
| Total plan assets at beginning of year | 2017-12-31 | $2,218,905 |
| Value of fidelity bond covering the plan | 2017-12-31 | $290,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $106,391 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $125 |
| Other income received | 2017-12-31 | $274,056 |
| Net income (gross income less expenses) | 2017-12-31 | $411,262 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $2,630,167 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $2,218,905 |
| Assets. Value of participant loans | 2017-12-31 | $817 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $44,829 |
| 2016 : KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2016 401k financial data |
|---|
| Total income from all sources | 2016-12-31 | $277,212 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $1,039,569 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $1,039,299 |
| Total plan assets at end of year | 2016-12-31 | $2,218,905 |
| Total plan assets at beginning of year | 2016-12-31 | $2,981,262 |
| Value of fidelity bond covering the plan | 2016-12-31 | $290,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $98,725 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $270 |
| Other income received | 2016-12-31 | $115,359 |
| Net income (gross income less expenses) | 2016-12-31 | $-762,357 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $2,218,905 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $2,981,262 |
| Assets. Value of participant loans | 2016-12-31 | $1,882 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $63,128 |
| 2015 : KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $118,936 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $20,660 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $20,585 |
| Total plan assets at end of year | 2015-12-31 | $2,981,262 |
| Total plan assets at beginning of year | 2015-12-31 | $2,882,986 |
| Value of fidelity bond covering the plan | 2015-12-31 | $300,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $110,613 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $75 |
| Other income received | 2015-12-31 | $-52,590 |
| Net income (gross income less expenses) | 2015-12-31 | $98,276 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $2,981,262 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $2,882,986 |
| Assets. Value of participant loans | 2015-12-31 | $2,895 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $60,913 |
| 2012 : KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2012 401k financial data |
|---|
| Total income from all sources | 2012-12-31 | $381,512 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $43,863 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $43,628 |
| Total plan assets at end of year | 2012-12-31 | $2,356,821 |
| Total plan assets at beginning of year | 2012-12-31 | $2,019,172 |
| Total contributions received or receivable from participants | 2012-12-31 | $70,864 |
| Other income received | 2012-12-31 | $206,970 |
| Net income (gross income less expenses) | 2012-12-31 | $337,649 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $2,356,821 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $2,019,172 |
| Assets. Value of participant loans | 2012-12-31 | $18,207 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $103,678 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $235 |
| 2011 : KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2011 401k financial data |
|---|
| Transfers to/from the plan | 2011-12-31 | $0 |
| Total income from all sources | 2011-12-31 | $7,631 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $23,943 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $23,783 |
| Total plan assets at end of year | 2011-12-31 | $2,019,172 |
| Total plan assets at beginning of year | 2011-12-31 | $2,035,484 |
| Total contributions received or receivable from participants | 2011-12-31 | $11,668 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $160 |
| Contributions received from other sources (not participants or employers) | 2011-12-31 | $0 |
| Other income received | 2011-12-31 | $-10,116 |
| Net income (gross income less expenses) | 2011-12-31 | $-16,312 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $2,019,172 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $2,035,484 |
| Assets. Value of participant loans | 2011-12-31 | $19,839 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $6,079 |
| Value of certain deemed distributions of participant loans | 2011-12-31 | $0 |
| Value of corrective distributions | 2011-12-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2011-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2011-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2011-12-31 | $0 |
| Transfers to/from the plan | 2011-04-30 | $0 |
| Total income from all sources | 2011-04-30 | $233,235 |
| Expenses. Total of all expenses incurred | 2011-04-30 | $27,832 |
| Benefits paid (including direct rollovers) | 2011-04-30 | $27,534 |
| Total plan assets at end of year | 2011-04-30 | $2,035,484 |
| Total plan assets at beginning of year | 2011-04-30 | $1,830,081 |
| Total contributions received or receivable from participants | 2011-04-30 | $19,621 |
| Expenses. Other expenses not covered elsewhere | 2011-04-30 | $298 |
| Contributions received from other sources (not participants or employers) | 2011-04-30 | $0 |
| Other income received | 2011-04-30 | $121,001 |
| Net income (gross income less expenses) | 2011-04-30 | $205,403 |
| Net plan assets at end of year (total assets less liabilities) | 2011-04-30 | $2,035,484 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-04-30 | $1,830,081 |
| Assets. Value of participant loans | 2011-04-30 | $20,516 |
| Total contributions received or receivable from employer(s) | 2011-04-30 | $92,613 |
| Value of certain deemed distributions of participant loans | 2011-04-30 | $0 |
| Value of corrective distributions | 2011-04-30 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2011-04-30 | $0 |
| Minimum employer required contribution for this plan year | 2011-04-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2011-04-30 | $0 |
| 2010 : KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2010 401k financial data |
|---|
| Transfers to/from the plan | 2010-04-30 | $0 |
| Total income from all sources | 2010-04-30 | $161,276 |
| Expenses. Total of all expenses incurred | 2010-04-30 | $100,083 |
| Benefits paid (including direct rollovers) | 2010-04-30 | $100,000 |
| Total plan assets at end of year | 2010-04-30 | $1,830,081 |
| Total plan assets at beginning of year | 2010-04-30 | $1,768,888 |
| Total contributions received or receivable from participants | 2010-04-30 | $5,690 |
| Expenses. Other expenses not covered elsewhere | 2010-04-30 | $83 |
| Contributions received from other sources (not participants or employers) | 2010-04-30 | $236 |
| Other income received | 2010-04-30 | $152,113 |
| Net income (gross income less expenses) | 2010-04-30 | $61,193 |
| Net plan assets at end of year (total assets less liabilities) | 2010-04-30 | $1,830,081 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-04-30 | $1,768,888 |
| Assets. Value of participant loans | 2010-04-30 | $3,517 |
| Total contributions received or receivable from employer(s) | 2010-04-30 | $3,237 |
| Value of certain deemed distributions of participant loans | 2010-04-30 | $0 |
| Value of corrective distributions | 2010-04-30 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2010-04-30 | $0 |
| Minimum employer required contribution for this plan year | 2010-04-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2010-04-30 | $0 |
| 2017: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2011 form 5500 responses |
|---|
| 2011-05-01 | Type of plan entity | Single employer plan |
| 2011-05-01 | Submission has been amended | No |
| 2011-05-01 | This submission is the final filing | No |
| 2011-05-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2011-05-01 | Plan is a collectively bargained plan | No |
| 2011-05-01 | Plan funding arrangement – Insurance | Yes |
| 2011-05-01 | Plan funding arrangement – Trust | Yes |
| 2011-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2010 form 5500 responses |
|---|
| 2010-05-01 | Type of plan entity | Single employer plan |
| 2010-05-01 | Submission has been amended | No |
| 2010-05-01 | This submission is the final filing | No |
| 2010-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-05-01 | Plan is a collectively bargained plan | No |
| 2010-05-01 | Plan funding arrangement – Insurance | Yes |
| 2010-05-01 | Plan funding arrangement – Trust | Yes |
| 2010-05-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: KINSTON PEDIATRIC ASSOCIATES, P.A. 401-K PLAN 2009 form 5500 responses |
|---|
| 2009-05-01 | Type of plan entity | Single employer plan |
| 2009-05-01 | Submission has been amended | No |
| 2009-05-01 | This submission is the final filing | No |
| 2009-05-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-05-01 | Plan is a collectively bargained plan | No |
| 2009-05-01 | Plan funding arrangement – Insurance | Yes |
| 2009-05-01 | Plan funding arrangement – Trust | Yes |
| 2009-05-01 | Plan benefit arrangement – Insurance | Yes |
| THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 ) |
| Policy contract number | GP4470 |
| Policy instance | 1 |
| Insurance contract or identification number | GP4470 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $11,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,154 | | Insurance broker organization code? | 3 | | Insurance broker name | GOLDEN MACK & ASSOCIATES, INC. |
|
| THE OHIO NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67172 ) |
| Policy contract number | GP4470 |
| Policy instance | 1 |
| Insurance contract or identification number | GP4470 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $14,713 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,471 | | Insurance broker organization code? | 3 | | Insurance broker name | THOMAS E. CLARK |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-712024 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-712024 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $3,891 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Commission paid to Insurance Broker | USD $3,891 | | Insurance broker organization code? | 3 | | Insurance broker name | FIRST CITIZENS INVESTOR SERVICES IN |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-712024 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-712024 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,589 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-712024 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-712024 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $5,287 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | Yes | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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