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LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 401k Plan overview

Plan NameLAETITIA VINEYARD & WINERY, INC. 401(K) PLAN
Plan identification number 001

LAETITIA VINEYARD & WINERY, INC. 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

LAETITIA VINEYARD & WINERY, INC. has sponsored the creation of one or more 401k plans.

Company Name:LAETITIA VINEYARD & WINERY, INC.
Employer identification number (EIN):954464519
NAIC Classification:312130
NAIC Description:Wineries

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012019-01-01WILLIAM C. PARKS2020-03-11
0012018-01-01WILLIAM C. PARKS2019-10-15
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01
0012013-01-01WENDELL COTTLE
0012012-01-01WENDELL COTTLE
0012011-01-01WENDELL COTTLE
0012010-01-01DOUGLAS S. HENDRY
0012009-01-01DAVID PECKHAM

Plan Statistics for LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN

401k plan membership statisitcs for LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN

Measure Date Value
2017: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0185
Total number of active participants reported on line 7a of the Form 55002017-01-0150
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-0118
Total of all active and inactive participants2017-01-0168
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0168
Number of participants with account balances2017-01-0151
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0173
Total number of active participants reported on line 7a of the Form 55002016-01-0162
Number of other retired or separated participants entitled to future benefits2016-01-0111
Total of all active and inactive participants2016-01-0173
Total participants2016-01-0173
Number of participants with account balances2016-01-0149
2015: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0191
Total number of active participants reported on line 7a of the Form 55002015-01-0163
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0110
Total of all active and inactive participants2015-01-0173
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0173
Number of participants with account balances2015-01-0150
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0174
Total number of active participants reported on line 7a of the Form 55002014-01-0191
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0191
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0191
Number of participants with account balances2014-01-0147
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0169
Total number of active participants reported on line 7a of the Form 55002013-01-0162
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-015
Total of all active and inactive participants2013-01-0167
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0167
Number of participants with account balances2013-01-0146
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0159
Total number of active participants reported on line 7a of the Form 55002012-01-0156
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-015
Total of all active and inactive participants2012-01-0161
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0161
Number of participants with account balances2012-01-0144
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0168
Total number of active participants reported on line 7a of the Form 55002011-01-0153
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-014
Total of all active and inactive participants2011-01-0157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0157
Number of participants with account balances2011-01-0128
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0157
Total number of active participants reported on line 7a of the Form 55002010-01-0150
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-0110
Total of all active and inactive participants2010-01-0160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0160
Number of participants with account balances2010-01-0130
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-012
2009: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0124
Total number of active participants reported on line 7a of the Form 55002009-01-0125
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0125
Number of participants with account balances2009-01-0125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN

Measure Date Value
2017 : LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2017 401k financial data
Total income from all sources2017-12-31$571,726
Expenses. Total of all expenses incurred2017-12-31$495,469
Benefits paid (including direct rollovers)2017-12-31$491,361
Total plan assets at end of year2017-12-31$2,428,044
Total plan assets at beginning of year2017-12-31$2,351,787
Value of fidelity bond covering the plan2017-12-31$250,000
Total contributions received or receivable from participants2017-12-31$209,995
Expenses. Other expenses not covered elsewhere2017-12-31$4,108
Other income received2017-12-31$273,666
Net income (gross income less expenses)2017-12-31$76,257
Net plan assets at end of year (total assets less liabilities)2017-12-31$2,428,044
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$2,351,787
Assets. Value of participant loans2017-12-31$56,725
Total contributions received or receivable from employer(s)2017-12-31$88,065
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$0
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$469,053
Expenses. Total of all expenses incurred2016-12-31$113,465
Benefits paid (including direct rollovers)2016-12-31$111,715
Total plan assets at end of year2016-12-31$2,351,787
Total plan assets at beginning of year2016-12-31$1,996,199
Value of fidelity bond covering the plan2016-12-31$150,000
Total contributions received or receivable from participants2016-12-31$203,983
Expenses. Other expenses not covered elsewhere2016-12-31$1,750
Contributions received from other sources (not participants or employers)2016-12-31$45,579
Other income received2016-12-31$134,886
Net income (gross income less expenses)2016-12-31$355,588
Net plan assets at end of year (total assets less liabilities)2016-12-31$2,351,787
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$1,996,199
Assets. Value of participant loans2016-12-31$64,378
Total contributions received or receivable from employer(s)2016-12-31$84,605
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2015 401k financial data
Total plan liabilities at end of year2015-12-31$0
Total plan liabilities at beginning of year2015-12-31$317
Total income from all sources2015-12-31$288,021
Expenses. Total of all expenses incurred2015-12-31$56,372
Benefits paid (including direct rollovers)2015-12-31$55,971
Total plan assets at end of year2015-12-31$1,996,199
Total plan assets at beginning of year2015-12-31$1,764,867
Value of fidelity bond covering the plan2015-12-31$150,000
Total contributions received or receivable from participants2015-12-31$218,030
Expenses. Other expenses not covered elsewhere2015-12-31$401
Other income received2015-12-31$-21,610
Net income (gross income less expenses)2015-12-31$231,649
Net plan assets at end of year (total assets less liabilities)2015-12-31$1,996,199
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$1,764,550
Assets. Value of participant loans2015-12-31$59,504
Total contributions received or receivable from employer(s)2015-12-31$91,601
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2014 401k financial data
Total plan liabilities at end of year2014-12-31$317
Total plan liabilities at beginning of year2014-12-31$329
Total income from all sources2014-12-31$361,941
Expenses. Total of all expenses incurred2014-12-31$109,212
Benefits paid (including direct rollovers)2014-12-31$108,555
Total plan assets at end of year2014-12-31$1,764,867
Total plan assets at beginning of year2014-12-31$1,512,150
Value of fidelity bond covering the plan2014-12-31$150,000
Total contributions received or receivable from participants2014-12-31$188,848
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$74,159
Net income (gross income less expenses)2014-12-31$252,729
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,764,550
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,511,821
Assets. Value of participant loans2014-12-31$74,702
Total contributions received or receivable from employer(s)2014-12-31$98,934
Value of certain deemed distributions of participant loans2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$657
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total plan liabilities at end of year2013-12-31$329
Total plan liabilities at beginning of year2013-12-31$5,440
Total income from all sources2013-12-31$365,568
Expenses. Total of all expenses incurred2013-12-31$41,961
Benefits paid (including direct rollovers)2013-12-31$41,508
Total plan assets at end of year2013-12-31$1,512,150
Total plan assets at beginning of year2013-12-31$1,193,654
Value of fidelity bond covering the plan2013-12-31$150,000
Total contributions received or receivable from participants2013-12-31$179,550
Expenses. Other expenses not covered elsewhere2013-12-31$453
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$104,391
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$323,607
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,511,821
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,188,214
Assets. Value of participant loans2013-12-31$107,186
Total contributions received or receivable from employer(s)2013-12-31$81,627
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total plan liabilities at end of year2012-12-31$5,440
Total plan liabilities at beginning of year2012-12-31$14,170
Total income from all sources2012-12-31$320,704
Expenses. Total of all expenses incurred2012-12-31$237,904
Benefits paid (including direct rollovers)2012-12-31$202,050
Total plan assets at end of year2012-12-31$1,193,654
Total plan assets at beginning of year2012-12-31$1,119,584
Value of fidelity bond covering the plan2012-12-31$150,000
Total contributions received or receivable from participants2012-12-31$153,351
Expenses. Other expenses not covered elsewhere2012-12-31$10,467
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$96,260
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$82,800
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,188,214
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,105,414
Assets. Value of participant loans2012-12-31$64,712
Total contributions received or receivable from employer(s)2012-12-31$71,093
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$25,387
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total plan liabilities at end of year2011-12-31$14,170
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$174,061
Expenses. Total of all expenses incurred2011-12-31$129,429
Benefits paid (including direct rollovers)2011-12-31$57,035
Total plan assets at end of year2011-12-31$1,119,584
Total plan assets at beginning of year2011-12-31$1,060,782
Value of fidelity bond covering the plan2011-12-31$150,000
Total contributions received or receivable from participants2011-12-31$111,305
Expenses. Other expenses not covered elsewhere2011-12-31$14,345
Contributions received from other sources (not participants or employers)2011-12-31$3,196
Other income received2011-12-31$4,322
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$44,632
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,105,414
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,060,782
Assets. Value of participant loans2011-12-31$22,539
Total contributions received or receivable from employer(s)2011-12-31$55,238
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$58,049
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$286,406
Expenses. Total of all expenses incurred2010-12-31$7,434
Benefits paid (including direct rollovers)2010-12-31$0
Total plan assets at end of year2010-12-31$1,060,782
Total plan assets at beginning of year2010-12-31$781,810
Total contributions received or receivable from participants2010-12-31$106,074
Expenses. Other expenses not covered elsewhere2010-12-31$7,434
Contributions received from other sources (not participants or employers)2010-12-31$10,000
Other income received2010-12-31$115,246
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$278,972
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,060,782
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$781,810
Assets. Value of participant loans2010-12-31$53,326
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022010-12-31$304
Total contributions received or receivable from employer(s)2010-12-31$55,086
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$0

Form 5500 Responses for LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN

2017: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
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: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
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: LAETITIA VINEYARD & WINERY, INC. 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
2013-01-01Plan benefit arrangement - TrustYes
2012: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedYes
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
2012-01-01Plan benefit arrangement - TrustYes
2011: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
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
2010: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: LAETITIA VINEYARD & WINERY, INC. 401(K) PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number824506
Policy instance 1
Insurance contract or identification number824506
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $9,730
Total amount of fees paid to insurance companyUSD $1,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,730
Insurance broker organization code?3
Amount paid for insurance broker fees1431
Insurance broker namePENSYS, INC.
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number824506
Policy instance 1
Insurance contract or identification number824506
Number of Individuals Covered50
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,933
Total amount of fees paid to insurance companyUSD $390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,933
Insurance broker organization code?3
Amount paid for insurance broker fees390
Additional information about fees paid to insurance brokerADMINISTRATIVE ALLOWANCE
Insurance broker namePENSYS, INC.
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number824506
Policy instance 1
Insurance contract or identification number824506
Number of Individuals Covered51
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,002
Commission paid to Insurance BrokerUSD $5,002
Insurance broker organization code?3
Insurance broker nameMERRILL LYNCH LIFE AGENCY INC.
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number824506
Policy instance 1
Insurance contract or identification number824506
Number of Individuals Covered46
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,313
Total amount of fees paid to insurance companyUSD $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 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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
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 $4,313
Insurance broker organization code?3
Insurance broker nameMERRILL LYNCH LIFE AGENCY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number824506
Policy instance 1
Insurance contract or identification number824506
Number of Individuals Covered44
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,472
Total amount of fees paid to insurance companyUSD $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 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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
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 $3,472
Insurance broker organization code?3
Insurance broker nameMERRILL LYNCH LIFE AGENCY
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number824506
Policy instance 1
Insurance contract or identification number824506
Number of Individuals Covered28
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $8,464
Total amount of fees paid to insurance companyUSD $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 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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
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
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number63948
Policy instance 1
Insurance contract or identification number63948
Number of Individuals Covered0
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
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

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