JEFFERSON COMMUNITY HEALTH CARE has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2014: JCHCC RETIREMENT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 99 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 84 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 32 |
| Total of all active and inactive participants | 2014-01-01 | 116 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-01-01 | 0 |
| Total participants | 2014-01-01 | 116 |
| Number of participants with account balances | 2014-01-01 | 98 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-01-01 | 7 |
| 2013: JCHCC RETIREMENT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 88 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 57 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 35 |
| Total of all active and inactive participants | 2013-01-01 | 92 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 0 |
| Total participants | 2013-01-01 | 92 |
| Number of participants with account balances | 2013-01-01 | 72 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-01-01 | 122 |
| 2012: JCHCC RETIREMENT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 87 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 61 |
| 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 | 36 |
| Total of all active and inactive participants | 2012-01-01 | 97 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 0 |
| Total participants | 2012-01-01 | 97 |
| Number of participants with account balances | 2012-01-01 | 61 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-01-01 | 116 |
| 2011: JCHCC RETIREMENT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 65 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 31 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 26 |
| Total of all active and inactive participants | 2011-01-01 | 57 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-01-01 | 0 |
| Total participants | 2011-01-01 | 57 |
| Number of participants with account balances | 2011-01-01 | 57 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-01-01 | 0 |
| 2010: JCHCC RETIREMENT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 68 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 62 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 62 |
| Total participants | 2010-01-01 | 62 |
| Number of participants with account balances | 2010-01-01 | 54 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-01-01 | 0 |
| 2009: JCHCC RETIREMENT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 48 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 49 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 10 |
| Total of all active and inactive participants | 2009-01-01 | 59 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 59 |
| Number of participants with account balances | 2009-01-01 | 57 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 4 |
| 2008: JCHCC RETIREMENT PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-01-01 | 41 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-01-01 | 26 |
| Number of retired or separated participants receiving benefits | 2008-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2008-01-01 | 21 |
| Total of all active and inactive participants | 2008-01-01 | 47 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2008-01-01 | 0 |
| Total participants | 2008-01-01 | 47 |
| Number of participants with account balances | 2008-01-01 | 47 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2008-01-01 | 6 |
| Measure | Date | Value |
|---|
| 2014 : JCHCC RETIREMENT PLAN 2014 401k financial data |
|---|
| Transfers to/from the plan | 2014-12-31 | $60 |
| Total income from all sources | 2014-12-31 | $315,399 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $245,879 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $227,999 |
| Total plan assets at end of year | 2014-12-31 | $1,017,275 |
| Total plan assets at beginning of year | 2014-12-31 | $947,695 |
| Value of fidelity bond covering the plan | 2014-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $152,300 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $1,368 |
| Contributions received from other sources (not participants or employers) | 2014-12-31 | $0 |
| Other income received | 2014-12-31 | $34,111 |
| Net income (gross income less expenses) | 2014-12-31 | $69,520 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $1,017,275 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $947,695 |
| Assets. Value of participant loans | 2014-12-31 | $45,502 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $128,988 |
| Value of certain deemed distributions of participant loans | 2014-12-31 | $0 |
| Value of corrective distributions | 2014-12-31 | $16,512 |
| Funding deficiency by the employer to the plan for this plan year | 2014-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2014-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2014-12-31 | $0 |
| 2013 : JCHCC RETIREMENT PLAN 2013 401k financial data |
|---|
| Transfers to/from the plan | 2013-12-31 | $0 |
| Total income from all sources | 2013-12-31 | $351,202 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $144,305 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $81,951 |
| Total plan assets at end of year | 2013-12-31 | $947,695 |
| Total plan assets at beginning of year | 2013-12-31 | $740,798 |
| Value of fidelity bond covering the plan | 2013-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $155,373 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $426 |
| Contributions received from other sources (not participants or employers) | 2013-12-31 | $0 |
| Other income received | 2013-12-31 | $120,716 |
| Net income (gross income less expenses) | 2013-12-31 | $206,897 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $947,695 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $740,798 |
| Assets. Value of participant loans | 2013-12-31 | $27,055 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $75,113 |
| Value of certain deemed distributions of participant loans | 2013-12-31 | $0 |
| Value of corrective distributions | 2013-12-31 | $61,928 |
| Funding deficiency by the employer to the plan for this plan year | 2013-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2013-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2013-12-31 | $0 |
| 2012 : JCHCC RETIREMENT PLAN 2012 401k financial data |
|---|
| Transfers to/from the plan | 2012-12-31 | $531 |
| Total income from all sources | 2012-12-31 | $219,640 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $33,152 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $32,612 |
| Total plan assets at end of year | 2012-12-31 | $740,798 |
| Total plan assets at beginning of year | 2012-12-31 | $553,779 |
| Value of fidelity bond covering the plan | 2012-12-31 | $100,000 |
| Total contributions received or receivable from participants | 2012-12-31 | $106,612 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $314 |
| Contributions received from other sources (not participants or employers) | 2012-12-31 | $0 |
| Other income received | 2012-12-31 | $62,382 |
| Net income (gross income less expenses) | 2012-12-31 | $186,488 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $740,798 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $553,779 |
| Assets. Value of participant loans | 2012-12-31 | $22,480 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $50,646 |
| Value of certain deemed distributions of participant loans | 2012-12-31 | $0 |
| Value of corrective distributions | 2012-12-31 | $226 |
| Funding deficiency by the employer to the plan for this plan year | 2012-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2012-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2012-12-31 | $0 |
| 2011 : JCHCC RETIREMENT PLAN 2011 401k financial data |
|---|
| Transfers to/from the plan | 2011-12-31 | $0 |
| Total income from all sources | 2011-12-31 | $147,515 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $87,068 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $86,582 |
| Total plan assets at end of year | 2011-12-31 | $553,779 |
| Total plan assets at beginning of year | 2011-12-31 | $493,332 |
| Total contributions received or receivable from participants | 2011-12-31 | $101,142 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $486 |
| Contributions received from other sources (not participants or employers) | 2011-12-31 | $0 |
| Other income received | 2011-12-31 | $-11,949 |
| Net income (gross income less expenses) | 2011-12-31 | $60,447 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $553,779 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $493,332 |
| Assets. Value of participant loans | 2011-12-31 | $20,929 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $58,322 |
| 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 |
| 2010 : JCHCC RETIREMENT PLAN 2010 401k financial data |
|---|
| Transfers to/from the plan | 2010-12-31 | $0 |
| Total plan liabilities at end of year | 2010-12-31 | $0 |
| Total plan liabilities at beginning of year | 2010-12-31 | $0 |
| Total income from all sources | 2010-12-31 | $162,996 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $84,397 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $68,415 |
| Total plan assets at end of year | 2010-12-31 | $493,332 |
| Total plan assets at beginning of year | 2010-12-31 | $414,733 |
| Assets. Value of tangible personal property | 2010-12-31 | $13,465 |
| Total contributions received or receivable from participants | 2010-12-31 | $68,569 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $276 |
| Contributions received from other sources (not participants or employers) | 2010-12-31 | $0 |
| Other income received | 2010-12-31 | $49,483 |
| Noncash contributions received | 2010-12-31 | $0 |
| Net income (gross income less expenses) | 2010-12-31 | $78,599 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $493,332 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $414,733 |
| Assets. Value of participant loans | 2010-12-31 | $13,465 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $44,944 |
| Value of certain deemed distributions of participant loans | 2010-12-31 | $0 |
| Value of corrective distributions | 2010-12-31 | $15,706 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-12-31 | $0 |
| Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers | 2010-12-31 | 0 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2010-12-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2010-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2010-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2010-12-31 | $0 |
| 2009 : JCHCC RETIREMENT PLAN 2009 401k financial data |
|---|
| Funding deficiency by the employer to the plan for this plan year | 2009-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2009-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2009-12-31 | $0 |
| 2008 : JCHCC RETIREMENT PLAN 2008 401k financial data |
|---|
| Transfers to/from the plan | 2008-12-31 | $0 |
| Total income from all sources | 2008-12-31 | $111,726 |
| Expenses. Total of all expenses incurred | 2008-12-31 | $50,211 |
| Benefits paid (including direct rollovers) | 2008-12-31 | $7,501 |
| Total plan assets at end of year | 2008-12-31 | $228,209 |
| Total plan assets at beginning of year | 2008-12-31 | $166,694 |
| Total contributions received or receivable from participants | 2008-12-31 | $109,200 |
| Expenses. Other expenses not covered elsewhere | 2008-12-31 | $1,784 |
| Contributions received from other sources (not participants or employers) | 2008-12-31 | $0 |
| Other income received | 2008-12-31 | $-72,502 |
| Noncash contributions received | 2008-12-31 | $0 |
| Net income (gross income less expenses) | 2008-12-31 | $61,515 |
| Net plan assets at end of year (total assets less liabilities) | 2008-12-31 | $228,209 |
| Net plan assets at beginning of year (total assets less liabilities) | 2008-12-31 | $166,694 |
| Assets. Value of participant loans | 2008-12-31 | $10,967 |
| Total contributions received or receivable from employer(s) | 2008-12-31 | $75,028 |
| Value of certain deemed distributions of participant loans | 2008-12-31 | $0 |
| Value of corrective distributions | 2008-12-31 | $40,926 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2008-12-31 | $0 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2008-12-31 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2008-12-31 | $0 |
| Minimum employer required contribution for this plan year | 2008-12-31 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2008-12-31 | $0 |
| 2014: JCHCC RETIREMENT PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: JCHCC RETIREMENT PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: JCHCC RETIREMENT 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 |
| 2011: JCHCC RETIREMENT PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: JCHCC RETIREMENT PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: JCHCC RETIREMENT PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: JCHCC RETIREMENT PLAN 2008 form 5500 responses |
|---|
| 2008-01-01 | Type of plan entity | Single employer plan |
| 2008-01-01 | Submission has been amended | No |
| 2008-01-01 | This submission is the final filing | No |
| 2008-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-01-01 | Plan is a collectively bargained plan | No |
| 2008-01-01 | Plan funding arrangement – Insurance | Yes |
| 2008-01-01 | Plan funding arrangement – Trust | Yes |
| 2008-01-01 | Plan benefit arrangement – Insurance | Yes |
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-803999 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-803999 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,293 | | 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 | | Commission paid to Insurance Broker | USD $3,293 | | Insurance broker organization code? | 3 | | Insurance broker name | EAGAN INS AGCY INC |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-803999 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-803999 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,257 | | 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 | | Commission paid to Insurance Broker | USD $3,257 | | Insurance broker organization code? | 3 | | Insurance broker name | EAGAN INS AGENCY INC |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-803999 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-803999 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,992 | | 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 | | Commission paid to Insurance Broker | USD $2,992 | | Insurance broker organization code? | 3 | | Insurance broker name | EAGAN INS AGENCY INC |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-803999 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-803999 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,623 | | 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-803999 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-803999 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,120 | | 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 number | GA-803999 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-803999 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2008-01-01 | | Insurance policy end date | 2008-12-31 | | Total amount of commissions paid to insurance broker | USD $762 | | Total amount of fees paid to insurance company | USD $0 | | 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 |
|
