YUKIMURA'S, INC. has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2014: YUKIMURA'S 401K PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 0 |
| Number of retired or separated participants receiving benefits | 2014-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 0 |
| Total of all active and inactive participants | 2014-10-01 | 0 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-10-01 | 0 |
| Total participants | 2014-10-01 | 0 |
| Number of participants with account balances | 2014-10-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-10-01 | 0 |
| 2013: YUKIMURA'S 401K PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 32 |
| Number of retired or separated participants receiving benefits | 2013-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 13 |
| Total of all active and inactive participants | 2013-10-01 | 45 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-10-01 | 0 |
| Total participants | 2013-10-01 | 45 |
| Number of participants with account balances | 2013-10-01 | 43 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-10-01 | 1 |
| 2012: YUKIMURA'S 401K PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 46 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 33 |
| Number of retired or separated participants receiving benefits | 2012-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-10-01 | 13 |
| Total of all active and inactive participants | 2012-10-01 | 46 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-10-01 | 0 |
| Total participants | 2012-10-01 | 46 |
| Number of participants with account balances | 2012-10-01 | 33 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-10-01 | 8 |
| 2011: YUKIMURA'S 401K PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 47 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 41 |
| Number of retired or separated participants receiving benefits | 2011-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-10-01 | 6 |
| Total of all active and inactive participants | 2011-10-01 | 47 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-10-01 | 0 |
| Total participants | 2011-10-01 | 47 |
| Number of participants with account balances | 2011-10-01 | 41 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-10-01 | 4 |
| 2010: YUKIMURA'S 401K PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-10-01 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-10-01 | 43 |
| Number of retired or separated participants receiving benefits | 2010-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-10-01 | 4 |
| Total of all active and inactive participants | 2010-10-01 | 47 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-10-01 | 0 |
| Total participants | 2010-10-01 | 47 |
| Number of participants with account balances | 2010-10-01 | 31 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-10-01 | 3 |
| 2009: YUKIMURA'S 401K PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 56 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 47 |
| Number of retired or separated participants receiving benefits | 2009-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-10-01 | 5 |
| Total of all active and inactive participants | 2009-10-01 | 52 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-10-01 | 0 |
| Total participants | 2009-10-01 | 52 |
| Number of participants with account balances | 2009-10-01 | 33 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-10-01 | 0 |
| Measure | Date | Value |
|---|
| 2015 : YUKIMURA'S 401K PLAN 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-08-31 | $0 |
| Total income from all sources | 2015-08-31 | $98,528 |
| Expenses. Total of all expenses incurred | 2015-08-31 | $1,405,282 |
| Benefits paid (including direct rollovers) | 2015-08-31 | $1,404,190 |
| Total plan assets at end of year | 2015-08-31 | $0 |
| Total plan assets at beginning of year | 2015-08-31 | $1,306,754 |
| Value of fidelity bond covering the plan | 2015-08-31 | $150,000 |
| Total contributions received or receivable from participants | 2015-08-31 | $16,384 |
| Other income received | 2015-08-31 | $82,142 |
| Net income (gross income less expenses) | 2015-08-31 | $-1,306,754 |
| Net plan assets at end of year (total assets less liabilities) | 2015-08-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-08-31 | $1,306,754 |
| Total contributions received or receivable from employer(s) | 2015-08-31 | $2 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-08-31 | $1,092 |
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2015-08-31 | $0 |
| 2014 : YUKIMURA'S 401K PLAN 2014 401k financial data |
|---|
| Transfers to/from the plan | 2014-09-30 | $0 |
| Total income from all sources | 2014-09-30 | $175,675 |
| Expenses. Total of all expenses incurred | 2014-09-30 | $247,090 |
| Benefits paid (including direct rollovers) | 2014-09-30 | $239,225 |
| Total plan assets at end of year | 2014-09-30 | $1,306,754 |
| Total plan assets at beginning of year | 2014-09-30 | $1,378,169 |
| Value of fidelity bond covering the plan | 2014-09-30 | $150,000 |
| Total contributions received or receivable from participants | 2014-09-30 | $41,964 |
| Expenses. Other expenses not covered elsewhere | 2014-09-30 | $648 |
| Contributions received from other sources (not participants or employers) | 2014-09-30 | $0 |
| Other income received | 2014-09-30 | $133,711 |
| Net income (gross income less expenses) | 2014-09-30 | $-71,415 |
| Net plan assets at end of year (total assets less liabilities) | 2014-09-30 | $1,306,754 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-09-30 | $1,378,169 |
| Assets. Value of participant loans | 2014-09-30 | $29,385 |
| Total contributions received or receivable from employer(s) | 2014-09-30 | $0 |
| Value of certain deemed distributions of participant loans | 2014-09-30 | $0 |
| Value of corrective distributions | 2014-09-30 | $7,217 |
| Funding deficiency by the employer to the plan for this plan year | 2014-09-30 | $0 |
| Minimum employer required contribution for this plan year | 2014-09-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2014-09-30 | $0 |
| 2013 : YUKIMURA'S 401K PLAN 2013 401k financial data |
|---|
| Transfers to/from the plan | 2013-09-30 | $0 |
| Total income from all sources | 2013-09-30 | $244,222 |
| Expenses. Total of all expenses incurred | 2013-09-30 | $5,136 |
| Benefits paid (including direct rollovers) | 2013-09-30 | $4,768 |
| Total plan assets at end of year | 2013-09-30 | $1,378,169 |
| Total plan assets at beginning of year | 2013-09-30 | $1,139,083 |
| Value of fidelity bond covering the plan | 2013-09-30 | $150,000 |
| Total contributions received or receivable from participants | 2013-09-30 | $65,272 |
| Expenses. Other expenses not covered elsewhere | 2013-09-30 | $368 |
| Contributions received from other sources (not participants or employers) | 2013-09-30 | $0 |
| Other income received | 2013-09-30 | $178,950 |
| Net income (gross income less expenses) | 2013-09-30 | $239,086 |
| Net plan assets at end of year (total assets less liabilities) | 2013-09-30 | $1,378,169 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-09-30 | $1,139,083 |
| Assets. Value of participant loans | 2013-09-30 | $11,138 |
| Total contributions received or receivable from employer(s) | 2013-09-30 | $0 |
| Value of certain deemed distributions of participant loans | 2013-09-30 | $0 |
| Value of corrective distributions | 2013-09-30 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2013-09-30 | $0 |
| Minimum employer required contribution for this plan year | 2013-09-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2013-09-30 | $0 |
| 2012 : YUKIMURA'S 401K PLAN 2012 401k financial data |
|---|
| Transfers to/from the plan | 2012-09-30 | $0 |
| Total income from all sources | 2012-09-30 | $244,016 |
| Expenses. Total of all expenses incurred | 2012-09-30 | $116,941 |
| Benefits paid (including direct rollovers) | 2012-09-30 | $116,669 |
| Total plan assets at end of year | 2012-09-30 | $1,139,083 |
| Total plan assets at beginning of year | 2012-09-30 | $1,012,008 |
| Value of fidelity bond covering the plan | 2012-09-30 | $150,000 |
| Total contributions received or receivable from participants | 2012-09-30 | $64,686 |
| Expenses. Other expenses not covered elsewhere | 2012-09-30 | $272 |
| Contributions received from other sources (not participants or employers) | 2012-09-30 | $0 |
| Other income received | 2012-09-30 | $179,330 |
| Net income (gross income less expenses) | 2012-09-30 | $127,075 |
| Net plan assets at end of year (total assets less liabilities) | 2012-09-30 | $1,139,083 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-09-30 | $1,012,008 |
| Assets. Value of participant loans | 2012-09-30 | $9,651 |
| Total contributions received or receivable from employer(s) | 2012-09-30 | $0 |
| Value of certain deemed distributions of participant loans | 2012-09-30 | $0 |
| Value of corrective distributions | 2012-09-30 | $0 |
| Funding deficiency by the employer to the plan for this plan year | 2012-09-30 | $0 |
| Minimum employer required contribution for this plan year | 2012-09-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2012-09-30 | $0 |
| 2011 : YUKIMURA'S 401K PLAN 2011 401k financial data |
|---|
| Transfers to/from the plan | 2011-09-30 | $0 |
| Total income from all sources | 2011-09-30 | $105,376 |
| Expenses. Total of all expenses incurred | 2011-09-30 | $525,677 |
| Benefits paid (including direct rollovers) | 2011-09-30 | $522,035 |
| Total plan assets at end of year | 2011-09-30 | $1,012,008 |
| Total plan assets at beginning of year | 2011-09-30 | $1,432,309 |
| Value of fidelity bond covering the plan | 2011-09-30 | $150,000 |
| Total contributions received or receivable from participants | 2011-09-30 | $72,251 |
| Expenses. Other expenses not covered elsewhere | 2011-09-30 | $612 |
| Contributions received from other sources (not participants or employers) | 2011-09-30 | $0 |
| Other income received | 2011-09-30 | $33,125 |
| Net income (gross income less expenses) | 2011-09-30 | $-420,301 |
| Net plan assets at end of year (total assets less liabilities) | 2011-09-30 | $1,012,008 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-09-30 | $1,432,309 |
| Assets. Value of participant loans | 2011-09-30 | $13,868 |
| Total contributions received or receivable from employer(s) | 2011-09-30 | $0 |
| Value of certain deemed distributions of participant loans | 2011-09-30 | $0 |
| Value of corrective distributions | 2011-09-30 | $3,030 |
| Funding deficiency by the employer to the plan for this plan year | 2011-09-30 | $0 |
| Minimum employer required contribution for this plan year | 2011-09-30 | $0 |
| Amount contributed by the employer to the plan for this plan year | 2011-09-30 | $0 |
| 2010 : YUKIMURA'S 401K PLAN 2010 401k financial data |
|---|
| Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities | 2010-09-30 | $0 |
| 2014: YUKIMURA'S 401K PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Submission has been amended | No |
| 2014-10-01 | This submission is the final filing | Yes |
| 2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2014-10-01 | Plan is a collectively bargained plan | No |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan funding arrangement – Trust | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: YUKIMURA'S 401K PLAN 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Submission has been amended | No |
| 2013-10-01 | This submission is the final filing | No |
| 2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-10-01 | Plan is a collectively bargained plan | No |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan funding arrangement – Trust | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: YUKIMURA'S 401K PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Submission has been amended | No |
| 2012-10-01 | This submission is the final filing | No |
| 2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-10-01 | Plan is a collectively bargained plan | No |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan funding arrangement – Trust | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: YUKIMURA'S 401K PLAN 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Submission has been amended | No |
| 2011-10-01 | This submission is the final filing | No |
| 2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-10-01 | Plan is a collectively bargained plan | No |
| 2011-10-01 | Plan funding arrangement – Insurance | Yes |
| 2011-10-01 | Plan funding arrangement – Trust | Yes |
| 2011-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: YUKIMURA'S 401K PLAN 2010 form 5500 responses |
|---|
| 2010-10-01 | Type of plan entity | Single employer plan |
| 2010-10-01 | Submission has been amended | No |
| 2010-10-01 | This submission is the final filing | No |
| 2010-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-10-01 | Plan is a collectively bargained plan | No |
| 2010-10-01 | Plan funding arrangement – Insurance | Yes |
| 2010-10-01 | Plan funding arrangement – Trust | Yes |
| 2010-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: YUKIMURA'S 401K PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Submission has been amended | No |
| 2009-10-01 | This submission is the final filing | No |
| 2009-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-10-01 | Plan is a collectively bargained plan | No |
| 2009-10-01 | Plan funding arrangement – Trust | Yes |
| 2009-10-01 | Plan benefit arrangement - Trust | Yes |
| 2008: YUKIMURA'S 401K PLAN 2008 form 5500 responses |
|---|
| 2008-10-01 | Submission has been amended | No |
| 2008-10-01 | This submission is the final filing | No |
| 2008-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-10-01 | Plan is a collectively bargained plan | No |
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-825653 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-825653 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $5,283 | | 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 $4,806 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SALES/MARKETING | | Insurance broker name | MERRILL LYNCH, PIERCE, FENNER & |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-825653 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-825653 | | Number of Individuals Covered | 43 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $4,984 | | Total amount of fees paid to insurance company | USD $503 | | 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 $4,984 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 503 | | Additional information about fees paid to insurance broker | SALES/MARKETING | | Insurance broker name | MERRILL LYNCH, PIERCE, FENNER & |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-825653 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-825653 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $4,710 | | Total amount of fees paid to insurance company | USD $469 | | 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 $4,710 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 469 | | Additional information about fees paid to insurance broker | SALES/MARKETING | | Insurance broker name | MERRILL LYNCH PIERCE FENNER SMITH I |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | GA-825653 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-825653 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $431 | | Total amount of fees paid to insurance company | USD $361 | | 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-825653 |
| Policy instance | 1 |
| Insurance contract or identification number | GA-825653 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $8,335 | | 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 |
|
