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FRONTLINE INSURANCE MANAGERS 401(K) PLAN 401k Plan overview

Plan NameFRONTLINE INSURANCE MANAGERS 401(K) PLAN
Plan identification number 001

FRONTLINE INSURANCE MANAGERS 401(K) 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 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

FRONTLINE HOMEOWNERS INSURANCE, INC. has sponsored the creation of one or more 401k plans.

Company Name:FRONTLINE HOMEOWNERS INSURANCE, INC.
Employer identification number (EIN):593498334
NAIC Classification:524210
NAIC Description:Insurance Agencies and Brokerages

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FRONTLINE INSURANCE MANAGERS 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012015-01-01JOHN A. STARR
0012014-01-01JOHN A. STARR DWAYNE WILLIAMS2015-10-13
0012013-01-01JOHN A. STARR DWAYNE WILLIAMS2014-09-17
0012012-01-01DWAYNE R. WILLIAMS DWAYNE R. WILLIAMS2013-07-22
0012011-01-01DWAYNE R. WILLIAMS

Plan Statistics for FRONTLINE INSURANCE MANAGERS 401(K) PLAN

401k plan membership statisitcs for FRONTLINE INSURANCE MANAGERS 401(K) PLAN

Measure Date Value
2015: FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01179
Total number of active participants reported on line 7a of the Form 55002015-01-01187
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0127
Total of all active and inactive participants2015-01-01214
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01214
Number of participants with account balances2015-01-01213
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-0116
2014: FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01137
Total number of active participants reported on line 7a of the Form 55002014-01-01165
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0114
Total of all active and inactive participants2014-01-01179
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-01179
Number of participants with account balances2014-01-01178
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-013
2013: FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01120
Total number of active participants reported on line 7a of the Form 55002013-01-01135
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0111
Total of all active and inactive participants2013-01-01146
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01146
Number of participants with account balances2013-01-01111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01101
Total number of active participants reported on line 7a of the Form 55002012-01-01102
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0112
Total of all active and inactive participants2012-01-01114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01114
Number of participants with account balances2012-01-01102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01100
Total number of active participants reported on line 7a of the Form 55002011-01-0191
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0115
Total of all active and inactive participants2011-01-01106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01106
Number of participants with account balances2011-01-0188
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010

Financial Data on FRONTLINE INSURANCE MANAGERS 401(K) PLAN

Measure Date Value
2015 : FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$2,516,027
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$275,878
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$272,433
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$2,852,482
Value of total assets at end of year2015-12-31$17,918,121
Value of total assets at beginning of year2015-12-31$15,677,972
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$3,445
Total interest from all sources2015-12-31$111
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$850,051
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$850,051
Administrative expenses professional fees incurred2015-12-31$3,445
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$1,158,848
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$115,479
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$2,240,149
Value of net assets at end of year (total assets less liabilities)2015-12-31$17,918,121
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$15,677,972
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in pooled separate accounts at end of year2015-12-31$14,759,870
Value of interest in pooled separate accounts at beginning of year2015-12-31$13,130,320
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$111
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$3,113,952
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$2,531,701
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-1,186,617
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$1,578,155
Employer contributions (assets) at end of year2015-12-31$44,299
Employer contributions (assets) at beginning of year2015-12-31$15,951
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$272,433
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31WITHUMSMITH & BROWN, PC
Accountancy firm EIN2015-12-31222027092
2014 : FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total income from all sources (including contributions)2014-12-31$3,212,187
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$622,609
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$621,559
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$2,378,997
Value of total assets at end of year2014-12-31$15,662,021
Value of total assets at beginning of year2014-12-31$13,072,443
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$1,050
Total interest from all sources2014-12-31$48
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$1,005,859
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$1,005,859
Administrative expenses professional fees incurred2014-12-31$1,050
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$1,007,326
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$120,338
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$2,589,578
Value of net assets at end of year (total assets less liabilities)2014-12-31$15,662,021
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$13,072,443
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in pooled separate accounts at end of year2014-12-31$13,130,320
Value of interest in pooled separate accounts at beginning of year2014-12-31$10,597,833
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$48
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-12-31$2,531,701
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-12-31$2,474,610
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$-172,717
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$1,251,333
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$621,559
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31WITHUMSMITH & BROWN, PC
Accountancy firm EIN2014-12-31222027092
2013 : FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2013 401k financial data
Total income from all sources2013-12-31$3,872,632
Expenses. Total of all expenses incurred2013-12-31$280,323
Benefits paid (including direct rollovers)2013-12-31$280,073
Total plan assets at end of year2013-12-31$13,072,443
Total plan assets at beginning of year2013-12-31$9,480,134
Value of fidelity bond covering the plan2013-12-31$500,000
Total contributions received or receivable from participants2013-12-31$771,717
Contributions received from other sources (not participants or employers)2013-12-31$372,834
Other income received2013-12-31$1,796,675
Net income (gross income less expenses)2013-12-31$3,592,309
Net plan assets at end of year (total assets less liabilities)2013-12-31$13,072,443
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$9,480,134
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022013-12-31$69
Total contributions received or receivable from employer(s)2013-12-31$931,406
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$250
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2012 401k financial data
Total income from all sources2012-12-31$2,362,122
Expenses. Total of all expenses incurred2012-12-31$144,603
Benefits paid (including direct rollovers)2012-12-31$144,403
Total plan assets at end of year2012-12-31$9,480,134
Total plan assets at beginning of year2012-12-31$7,262,615
Value of fidelity bond covering the plan2012-12-31$500,000
Total contributions received or receivable from participants2012-12-31$669,619
Contributions received from other sources (not participants or employers)2012-12-31$1,594
Other income received2012-12-31$894,701
Net income (gross income less expenses)2012-12-31$2,217,519
Net plan assets at end of year (total assets less liabilities)2012-12-31$9,480,134
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$7,262,615
Total contributions received or receivable from employer(s)2012-12-31$796,208
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$200
Funding deficiency by the employer to the plan for this plan year2012-12-31$0
Minimum employer required contribution for this plan year2012-12-31$0
Amount contributed by the employer to the plan for this plan year2012-12-31$0
2011 : FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2011 401k financial data
Total income from all sources2011-12-31$1,128,330
Expenses. Total of all expenses incurred2011-12-31$568,405
Benefits paid (including direct rollovers)2011-12-31$568,080
Total plan assets at end of year2011-12-31$7,262,615
Total plan assets at beginning of year2011-12-31$6,702,690
Value of fidelity bond covering the plan2011-12-31$500,000
Total contributions received or receivable from participants2011-12-31$560,253
Contributions received from other sources (not participants or employers)2011-12-31$73,356
Other income received2011-12-31$-217,274
Net income (gross income less expenses)2011-12-31$559,925
Net plan assets at end of year (total assets less liabilities)2011-12-31$7,262,615
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$6,702,690
Total contributions received or receivable from employer(s)2011-12-31$711,995
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$325
2010 : FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2010 401k financial data
Total income from all sources2010-12-31$1,904,991
Expenses. Total of all expenses incurred2010-12-31$72,740
Benefits paid (including direct rollovers)2010-12-31$72,365
Total plan assets at end of year2010-12-31$6,702,690
Total plan assets at beginning of year2010-12-31$4,870,439
Value of fidelity bond covering the plan2010-12-31$500,000
Total contributions received or receivable from participants2010-12-31$520,677
Contributions received from other sources (not participants or employers)2010-12-31$16,448
Other income received2010-12-31$745,766
Net income (gross income less expenses)2010-12-31$1,832,251
Net plan assets at end of year (total assets less liabilities)2010-12-31$6,702,690
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$4,870,439
Total contributions received or receivable from employer(s)2010-12-31$622,100
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$375

Form 5500 Responses for FRONTLINE INSURANCE MANAGERS 401(K) PLAN

2015: FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: FRONTLINE INSURANCE MANAGERS 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-822648
Policy instance 1
Insurance contract or identification numberGA-822648
Number of Individuals Covered212
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $49,441
Total amount of fees paid to insurance companyUSD $6,580
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 $41,201
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
Insurance broker nameMERRILL LYNCH, PIERCE, FENNER
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-822648
Policy instance 1
Insurance contract or identification numberGA-822648
Number of Individuals Covered178
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $39,040
Total amount of fees paid to insurance companyUSD $5,423
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 $33,817
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
Insurance broker nameFIRST PARTY ADMINISTRATOR, LLC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-822648
Policy instance 1
Insurance contract or identification numberGA-822648
Number of Individuals Covered111
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $25,907
Total amount of fees paid to insurance companyUSD $4,135
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 $25,907
Insurance broker organization code?3
Amount paid for insurance broker fees4135
Additional information about fees paid to insurance brokerSALES/MARKETING
Insurance broker nameMERRILL LYNCH PIERCE FENNER SMITH I
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-822648
Policy instance 1
Insurance contract or identification numberGA-822648
Number of Individuals Covered102
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $19,953
Total amount of fees paid to insurance companyUSD $3,192
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 $19,953
Insurance broker organization code?3
Amount paid for insurance broker fees3192
Additional information about fees paid to insurance brokerSALES/MARKETING
Insurance broker nameMERRILL LYNCH PIERCE FENNER SMITH I
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-822648
Policy instance 1
Insurance contract or identification numberGA-822648
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $30,208
Total amount of fees paid to insurance companyUSD $669
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-822648
Policy instance 1
Insurance contract or identification numberGA-822648
Number of Individuals Covered85
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $30,208
Total amount of fees paid to insurance companyUSD $669
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?Yes
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Commission paid to Insurance BrokerUSD $30,208
Insurance broker organization code?3
Amount paid for insurance broker fees669
Additional information about fees paid to insurance brokerMARKETING FEES
Insurance broker nameMERRILL LYNCH PIERCE FENNER SMITH

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