| EIN |
06-0974148 |
| Industry Code |
88072 |
| Contract Number |
GA-822271 |
| Contract Year |
01/01/2010 — 12/31/2010 |
| Value in General Account at Year End |
$0 |
| Value in Separate Accounts at Year End |
$3,669,498 |
| |
| |
| Agent/Broker |
Organization Code |
Commissions Paid |
Fees Paid |
Purpose of Fees Paid |
|
Invest Fin Corp Ins Agency Inc. of
|
Insurance Agent or Broker |
$35,986 |
$0 |
|
|
| |
| Type of Contract |
Unspecified |
| Basis of premium rates |
|
| Premiums paid to carrier |
$0 |
| Premiums due but unpaid at the end of the year |
$0 |
| If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount |
$0 |
| Specify the nature of the costs |
|
|
| |
| Type of Contract |
Unspecified
|
| Balance at the end of the previous year |
$0 |
|
Additions |
$3,393,725 |
| Contributions Deposited during the year |
$0 |
| Dividends and credits |
$0 |
| Interest credited during the year |
$4,945 |
| Transferred from separate account |
$0 |
| Other |
$3,388,780 |
|
| Total of Balance and Additions |
$3,393,725 |
|
Deductions |
$3,393,725 |
| Disbursed from fund to pay benefits or purchase annuities during the year |
$0 |
| Administration charge made by carrier |
$0 |
| Transferred to Separate Account |
$3,393,725 |
| Other |
$0 |
|
| Balance at the end of the current year |
$0 |
|
|
| EIN |
01-0233346 |
| Industry Code |
65838 |
| Contract Number |
67735 |
| Contract Year |
01/01/2010 — 12/31/2010 |
| Value in General Account at Year End |
$0 |
| Value in Separate Accounts at Year End |
$0 |
| |
| |
| Agent/Broker |
Organization Code |
Commissions Paid |
Fees Paid |
Purpose of Fees Paid |
Tristate Plan Administration
Garfield Place, Suite 520
Cincinnati,
OH
45202
|
Third Party Administrator |
$0 |
$7,651 |
TPA FEES PAID |
Invest Financial Corp. Ins. Agency
Address Not Provided
Address Not Provided,
AL
45111
|
Insurance Agent or Broker |
$4,700 |
$0 |
|
Tri State Plan Administration
30 Garfield Place, Suite 520
Cincinnati,
OH
45202
|
Third Party Administrator |
$0 |
$609 |
TPA COMPENSATION |
|
| |
| Type of Contract |
Unspecified |
| Basis of premium rates |
|
| Premiums paid to carrier |
$0 |
| Premiums due but unpaid at the end of the year |
$0 |
| If the carrier, service, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amount |
$0 |
| Specify the nature of the costs |
|
|
| |
| Type of Contract |
Unspecified
|
| Balance at the end of the previous year |
$961 |
|
Additions |
$179 |
| Contributions Deposited during the year |
$171 |
| Dividends and credits |
$0 |
| Interest credited during the year |
$8 |
| Transferred from separate account |
$0 |
| Other |
$0 |
|
| Total of Balance and Additions |
$1,140 |
|
Deductions |
$1,140 |
| Disbursed from fund to pay benefits or purchase annuities during the year |
$1,040 |
| Administration charge made by carrier |
$0 |
| Transferred to Separate Account |
$0 |
| Other |
$100 |
|
| Balance at the end of the current year |
$0 |
|
|
