401k Plan data: NEW OMNI BANK N.A. 401K PS PLAN plan

NEW OMNI BANK N.A. 401K PS PLAN 401k Plan overview

Plan Name	NEW OMNI BANK N.A. 401K PS PLAN
Plan identification number	002

NEW OMNI BANK N.A. 401K PS PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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.
Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.

401k Sponsoring company profile

NEW OMNI BANK, N.A. has sponsored the creation of one or more 401k plans.

Company Name: NEW OMNI BANK, N.A.

Employer identification number (EIN): 953415769

NAIC Classification: 522110
NAIC Description: Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NEW OMNI BANK N.A. 401K PS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2023-01-01 SHIRLEY HORNER 2024-08-27
002 2022-01-01 NICK RICE 2023-06-22
002 2021-01-01 SHIRLEY HORNER 2022-07-29
002 2020-01-01 EDYTHE REPOFF 2021-06-28 EDYTHE REPOFF 2021-06-28
002 2019-01-01 EDYTHE REPOFF 2020-07-21 EDYTHE REPOFF 2020-07-21
002 2018-01-01 EDYTHE REPOFF 2019-09-25 EDYTHE REPOFF 2019-09-25
002 2017-01-01 EDYTHE REPOFF 2018-06-14 EDYTHE REPOFF 2018-06-14
002 2016-01-01 VERONICA CHEN 2017-06-07 VERONICA CHEN 2017-06-07
002 2015-01-01 VERONICA CHEN 2016-06-16
002 2014-01-01 VERONICA CHEN
002 2013-01-01 VERONICA CHEN
002 2012-01-01 VERONICA CHEN
002 2011-01-01 VERONICA CHEN
002 2010-01-01 SHIH-PING JIN 2011-07-08 SHIH-PING JIN 2011-07-08
002 2009-01-01 SHIH-PING JIN SHIH-PING JIN 2010-07-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
002	2023-01-01	SHIRLEY HORNER	2024-08-27
002	2022-01-01	NICK RICE	2023-06-22
002	2021-01-01	SHIRLEY HORNER	2022-07-29
002	2020-01-01	EDYTHE REPOFF	2021-06-28	EDYTHE REPOFF	2021-06-28
002	2019-01-01	EDYTHE REPOFF	2020-07-21	EDYTHE REPOFF	2020-07-21
002	2018-01-01	EDYTHE REPOFF	2019-09-25	EDYTHE REPOFF	2019-09-25
002	2017-01-01	EDYTHE REPOFF	2018-06-14	EDYTHE REPOFF	2018-06-14
002	2016-01-01	VERONICA CHEN	2017-06-07	VERONICA CHEN	2017-06-07
002	2015-01-01	VERONICA CHEN	2016-06-16
002	2014-01-01	VERONICA CHEN
002	2013-01-01	VERONICA CHEN
002	2012-01-01	VERONICA CHEN
002	2011-01-01	VERONICA CHEN
002	2010-01-01	SHIH-PING JIN	2011-07-08	SHIH-PING JIN	2011-07-08
002	2009-01-01	SHIH-PING JIN		SHIH-PING JIN	2010-07-14

Plan Statistics for NEW OMNI BANK N.A. 401K PS PLAN

401k plan membership statisitcs for NEW OMNI BANK N.A. 401K PS PLAN

Measure Date Value
2014: NEW OMNI BANK N.A. 401K PS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 70
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 38
Number of retired or separated participants receiving benefits 2014-01-01 1
Number of other retired or separated participants entitled to future benefits 2014-01-01 29
Total of all active and inactive participants 2014-01-01 68
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 68
Number of participants with account balances 2014-01-01 67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 9
2013: NEW OMNI BANK N.A. 401K PS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 45
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 28
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 22
Total of all active and inactive participants 2013-01-01 50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 50
Number of participants with account balances 2013-01-01 49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 17
2012: NEW OMNI BANK N.A. 401K PS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 27
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 20
Total of all active and inactive participants 2012-01-01 47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 47
Number of participants with account balances 2012-01-01 27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 17
2011: NEW OMNI BANK N.A. 401K PS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 54
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 28
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 17
Total of all active and inactive participants 2011-01-01 45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 45
Number of participants with account balances 2011-01-01 45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: NEW OMNI BANK N.A. 401K PS PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 66
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 46
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 11
Total of all active and inactive participants 2009-01-01 57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 57
Number of participants with account balances 2009-01-01 55
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: NEW OMNI BANK N.A. 401K PS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	70
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	38
Number of retired or separated participants receiving benefits	2014-01-01	1
Number of other retired or separated participants entitled to future benefits	2014-01-01	29
Total of all active and inactive participants	2014-01-01	68
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	68
Number of participants with account balances	2014-01-01	67
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	9
2013: NEW OMNI BANK N.A. 401K PS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	45
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	28
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	22
Total of all active and inactive participants	2013-01-01	50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	50
Number of participants with account balances	2013-01-01	49
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	17
2012: NEW OMNI BANK N.A. 401K PS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	27
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	20
Total of all active and inactive participants	2012-01-01	47
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	47
Number of participants with account balances	2012-01-01	27
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	17
2011: NEW OMNI BANK N.A. 401K PS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	54
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	28
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	17
Total of all active and inactive participants	2011-01-01	45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	45
Number of participants with account balances	2011-01-01	45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: NEW OMNI BANK N.A. 401K PS PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	66
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	46
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	11
Total of all active and inactive participants	2009-01-01	57
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	57
Number of participants with account balances	2009-01-01	55
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on NEW OMNI BANK N.A. 401K PS PLAN

Measure	Date	Value
2014 : NEW OMNI BANK N.A. 401K PS PLAN 2014 401k financial data
Transfers to/from the plan	2014-12-31	$5
Total income from all sources	2014-12-31	$559,614
Expenses. Total of all expenses incurred	2014-12-31	$170,375
Benefits paid (including direct rollovers)	2014-12-31	$167,481
Total plan assets at end of year	2014-12-31	$2,974,979
Total plan assets at beginning of year	2014-12-31	$2,585,735
Value of fidelity bond covering the plan	2014-12-31	$1,000,000
Total contributions received or receivable from participants	2014-12-31	$281,570
Expenses. Other expenses not covered elsewhere	2014-12-31	$2,894
Contributions received from other sources (not participants or employers)	2014-12-31	$98,571
Other income received	2014-12-31	$120,167
Net income (gross income less expenses)	2014-12-31	$389,239
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$2,974,979
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$2,585,735
Assets. Value of participant loans	2014-12-31	$0
Total contributions received or receivable from employer(s)	2014-12-31	$59,306
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 : NEW OMNI BANK N.A. 401K PS PLAN 2013 401k financial data
Transfers to/from the plan	2013-12-31	$15
Total income from all sources	2013-12-31	$480,735
Expenses. Total of all expenses incurred	2013-12-31	$233,851
Benefits paid (including direct rollovers)	2013-12-31	$229,750
Total plan assets at end of year	2013-12-31	$2,585,735
Total plan assets at beginning of year	2013-12-31	$2,338,836
Value of fidelity bond covering the plan	2013-12-31	$1,000,000
Total contributions received or receivable from participants	2013-12-31	$178,273
Expenses. Other expenses not covered elsewhere	2013-12-31	$4,101
Contributions received from other sources (not participants or employers)	2013-12-31	$6,141
Other income received	2013-12-31	$254,961
Net income (gross income less expenses)	2013-12-31	$246,884
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$2,585,735
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$2,338,836
Assets. Value of participant loans	2013-12-31	$0
Total contributions received or receivable from employer(s)	2013-12-31	$41,360
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 : NEW OMNI BANK N.A. 401K PS PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$11
Total income from all sources	2012-12-31	$572,415
Expenses. Total of all expenses incurred	2012-12-31	$377,588
Benefits paid (including direct rollovers)	2012-12-31	$373,650
Total plan assets at end of year	2012-12-31	$2,338,836
Total plan assets at beginning of year	2012-12-31	$2,143,998
Value of fidelity bond covering the plan	2012-12-31	$1,000,000
Total contributions received or receivable from participants	2012-12-31	$184,802
Expenses. Other expenses not covered elsewhere	2012-12-31	$3,938
Contributions received from other sources (not participants or employers)	2012-12-31	$198,670
Other income received	2012-12-31	$148,802
Net income (gross income less expenses)	2012-12-31	$194,827
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$2,338,836
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$2,143,998
Assets. Value of participant loans	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$40,141
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 : NEW OMNI BANK N.A. 401K PS PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$175,412
Expenses. Total of all expenses incurred	2011-12-31	$697,226
Benefits paid (including direct rollovers)	2011-12-31	$694,832
Total plan assets at end of year	2011-12-31	$2,143,998
Total plan assets at beginning of year	2011-12-31	$2,665,812
Total contributions received or receivable from participants	2011-12-31	$181,730
Expenses. Other expenses not covered elsewhere	2011-12-31	$2,137
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$-39,251
Net income (gross income less expenses)	2011-12-31	$-521,814
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$2,143,998
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$2,665,812
Assets. Value of participant loans	2011-12-31	$0
Total contributions received or receivable from employer(s)	2011-12-31	$32,933
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$257
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

Form 5500 Responses for NEW OMNI BANK N.A. 401K PS PLAN

2014: NEW OMNI BANK N.A. 401K PS 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: NEW OMNI BANK N.A. 401K PS 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: NEW OMNI BANK N.A. 401K PS 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: NEW OMNI BANK N.A. 401K PS 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
2009: NEW OMNI BANK N.A. 401K PS 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 - Trust	Yes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-824252

Policy instance

Insurance contract or identification number	GA-824252
Number of Individuals Covered	67
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,206
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 $8,206
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-824252

Policy instance

Insurance contract or identification number	GA-824252
Number of Individuals Covered	49
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,245
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 $7,245
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-824252

Policy instance

Insurance contract or identification number	GA-824252
Number of Individuals Covered	27
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,955
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 $3,299
Insurance broker organization code?	3
Insurance broker name	MERRILL LYNCH LIFE AGENCY

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )

Policy contract number

GA-824252

Policy instance

Insurance contract or identification number	GA-824252
Number of Individuals Covered	45
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $21,602
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	NEW OMNI BANK, N.A.
Employer identification number (EIN):	953415769
NAIC Classification:	522110
NAIC Description:	Commercial Banking