LUSK STATE BANK has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2014: LSB RETIREMENT FUND 401(K) 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 13 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 8 |
| 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 | 5 |
| Total of all active and inactive participants | 2014-01-01 | 13 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-01-01 | 0 |
| Total participants | 2014-01-01 | 13 |
| Number of participants with account balances | 2014-01-01 | 13 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-01-01 | 0 |
| 2013: LSB RETIREMENT FUND 401(K) 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 9 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 10 |
| 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 | 2 |
| Total of all active and inactive participants | 2013-01-01 | 12 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-01-01 | 0 |
| Total participants | 2013-01-01 | 12 |
| Number of participants with account balances | 2013-01-01 | 12 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-01-01 | 0 |
| 2012: LSB RETIREMENT FUND 401(K) 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 11 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 8 |
| 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 | 3 |
| Total of all active and inactive participants | 2012-01-01 | 11 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-01-01 | 0 |
| Total participants | 2012-01-01 | 11 |
| Number of participants with account balances | 2012-01-01 | 8 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-01-01 | 0 |
| 2011: LSB RETIREMENT FUND 401(K) 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 11 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 10 |
| 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 | 1 |
| Total of all active and inactive participants | 2011-01-01 | 11 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-01-01 | 0 |
| Total participants | 2011-01-01 | 11 |
| Number of participants with account balances | 2011-01-01 | 11 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-01-01 | 0 |
| 2010: LSB RETIREMENT FUND 401(K) 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 11 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 10 |
| 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 | 1 |
| Total of all active and inactive participants | 2010-01-01 | 11 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 11 |
| Number of participants with account balances | 2010-01-01 | 11 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-01-01 | 0 |
| 2009: LSB RETIREMENT FUND 401(K) 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 12 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 11 |
| 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 | 1 |
| Total of all active and inactive participants | 2009-01-01 | 12 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Total participants | 2009-01-01 | 12 |
| Number of participants with account balances | 2009-01-01 | 12 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 0 |
| Measure | Date | Value |
|---|
| 2014 : LSB RETIREMENT FUND 401(K) 2014 401k financial data |
|---|
| Transfers to/from the plan | 2014-12-31 | $0 |
| Total income from all sources | 2014-12-31 | $89,698 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $1,317 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $1,285 |
| Total plan assets at end of year | 2014-12-31 | $808,259 |
| Total plan assets at beginning of year | 2014-12-31 | $719,878 |
| Value of fidelity bond covering the plan | 2014-12-31 | $1,525,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $24,788 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $32 |
| Contributions received from other sources (not participants or employers) | 2014-12-31 | $0 |
| Other income received | 2014-12-31 | $40,122 |
| Net income (gross income less expenses) | 2014-12-31 | $88,381 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $808,259 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $719,878 |
| Assets. Value of participant loans | 2014-12-31 | $12,949 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $24,788 |
| Value of certain deemed distributions of participant loans | 2014-12-31 | $0 |
| Value of corrective distributions | 2014-12-31 | $0 |
| 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 : LSB RETIREMENT FUND 401(K) 2013 401k financial data |
|---|
| Transfers to/from the plan | 2013-12-31 | $0 |
| Total income from all sources | 2013-12-31 | $175,111 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $46,686 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $46,612 |
| Total plan assets at end of year | 2013-12-31 | $719,879 |
| Total plan assets at beginning of year | 2013-12-31 | $591,454 |
| Value of fidelity bond covering the plan | 2013-12-31 | $1,525,000 |
| Total contributions received or receivable from participants | 2013-12-31 | $24,746 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $74 |
| Contributions received from other sources (not participants or employers) | 2013-12-31 | $0 |
| Other income received | 2013-12-31 | $125,619 |
| Net income (gross income less expenses) | 2013-12-31 | $128,425 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $719,879 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $591,454 |
| Assets. Value of participant loans | 2013-12-31 | $18,044 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $24,746 |
| Value of certain deemed distributions of participant loans | 2013-12-31 | $0 |
| Value of corrective distributions | 2013-12-31 | $0 |
| 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 : LSB RETIREMENT FUND 401(K) 2012 401k financial data |
|---|
| Transfers to/from the plan | 2012-12-31 | $0 |
| Total income from all sources | 2012-12-31 | $110,314 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $1,236 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $1,170 |
| Total plan assets at end of year | 2012-12-31 | $591,454 |
| Total plan assets at beginning of year | 2012-12-31 | $482,376 |
| Value of fidelity bond covering the plan | 2012-12-31 | $1,525,000 |
| Total contributions received or receivable from participants | 2012-12-31 | $22,155 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $66 |
| Contributions received from other sources (not participants or employers) | 2012-12-31 | $0 |
| Other income received | 2012-12-31 | $66,004 |
| Net income (gross income less expenses) | 2012-12-31 | $109,078 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $591,454 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $482,376 |
| Assets. Value of participant loans | 2012-12-31 | $4,657 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $22,155 |
| Value of certain deemed distributions of participant loans | 2012-12-31 | $0 |
| Value of corrective distributions | 2012-12-31 | $0 |
| 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 : LSB RETIREMENT FUND 401(K) 2011 401k financial data |
|---|
| Transfers to/from the plan | 2011-12-31 | $0 |
| Total income from all sources | 2011-12-31 | $14,547 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $31,011 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $30,995 |
| Total plan assets at end of year | 2011-12-31 | $482,376 |
| Total plan assets at beginning of year | 2011-12-31 | $498,840 |
| Value of fidelity bond covering the plan | 2011-12-31 | $1,525,000 |
| Total contributions received or receivable from participants | 2011-12-31 | $23,898 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $16 |
| Contributions received from other sources (not participants or employers) | 2011-12-31 | $0 |
| Other income received | 2011-12-31 | $-33,249 |
| Net income (gross income less expenses) | 2011-12-31 | $-16,464 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $482,376 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $498,840 |
| Assets. Value of participant loans | 2011-12-31 | $339 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $23,898 |
| 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 : LSB RETIREMENT FUND 401(K) 2010 401k financial data |
|---|
| Transfers to/from the plan | 2010-12-31 | $0 |
| Total income from all sources | 2010-12-31 | $102,622 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $16 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $0 |
| Total plan assets at end of year | 2010-12-31 | $498,840 |
| Total plan assets at beginning of year | 2010-12-31 | $396,234 |
| Value of fidelity bond covering the plan | 2010-12-31 | $1,525,000 |
| Total contributions received or receivable from participants | 2010-12-31 | $23,988 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $16 |
| Contributions received from other sources (not participants or employers) | 2010-12-31 | $0 |
| Other income received | 2010-12-31 | $54,823 |
| Net income (gross income less expenses) | 2010-12-31 | $102,606 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $498,840 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $396,234 |
| Assets. Value of participant loans | 2010-12-31 | $815 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $23,811 |
| Value of certain deemed distributions of participant loans | 2010-12-31 | $0 |
| Value of corrective distributions | 2010-12-31 | $0 |
| 2009 : LSB RETIREMENT FUND 401(K) 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 : LSB RETIREMENT FUND 401(K) 2008 401k financial data |
|---|
| Transfers to/from the plan | 2008-12-31 | $0 |
| Total income from all sources | 2008-12-31 | $-108,874 |
| Expenses. Total of all expenses incurred | 2008-12-31 | $10,418 |
| Benefits paid (including direct rollovers) | 2008-12-31 | $10,000 |
| Total plan assets at end of year | 2008-12-31 | $253,940 |
| Total plan assets at beginning of year | 2008-12-31 | $373,232 |
| Value of fidelity bond covering the plan | 2008-12-31 | $1,525,000 |
| Total contributions received or receivable from participants | 2008-12-31 | $23,843 |
| Expenses. Other expenses not covered elsewhere | 2008-12-31 | $418 |
| Contributions received from other sources (not participants or employers) | 2008-12-31 | $0 |
| Other income received | 2008-12-31 | $-155,645 |
| Net income (gross income less expenses) | 2008-12-31 | $-119,292 |
| Net plan assets at end of year (total assets less liabilities) | 2008-12-31 | $253,940 |
| Net plan assets at beginning of year (total assets less liabilities) | 2008-12-31 | $373,232 |
| Assets. Value of participant loans | 2008-12-31 | $1,500 |
| Total contributions received or receivable from employer(s) | 2008-12-31 | $22,928 |
| Value of certain deemed distributions of participant loans | 2008-12-31 | $0 |
| Value of corrective distributions | 2008-12-31 | $0 |
| 2014: LSB RETIREMENT FUND 401(K) 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: LSB RETIREMENT FUND 401(K) 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: LSB RETIREMENT FUND 401(K) 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: LSB RETIREMENT FUND 401(K) 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: LSB RETIREMENT FUND 401(K) 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: LSB RETIREMENT FUND 401(K) 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 |
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-029922 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-029922 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $4,339 | | 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 $4,339 | | Insurance broker organization code? | 3 | | Insurance broker name | UBS FINANCIAL SERVICES |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-029922 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-029922 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,550 | | 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 $3,550 | | Insurance broker organization code? | 3 | | Insurance broker name | UBS FINANCIAL SVCS INS AGCY |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-029922 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-029922 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,074 | | 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 $3,074 | | Insurance broker organization code? | 3 | | Insurance broker name | UBS FINANCIAL SVCS INS AGCY |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-029922 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-029922 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,967 | | 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-029922 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-029922 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $2,417 | | 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 $2,417 | | Insurance broker organization code? | 3 | | Insurance broker name | UBS FINANCIAL SVCS INS AGCY |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-029922 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-029922 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2008-01-01 | | Insurance policy end date | 2008-12-31 | | Total amount of commissions paid to insurance broker | USD $2,123 | | 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 |
|
