| EIN |
01-0233346 |
| Industry Code |
65838 |
| Contract Number |
73338 |
| Contract Year |
01/01/2010 — 12/31/2010 |
| Value in General Account at Year End |
$45,442 |
| Value in Separate Accounts at Year End |
$586,956 |
| |
| |
| Agent/Broker |
Organization Code |
Commissions Paid |
Fees Paid |
Purpose of Fees Paid |
|
Stofan Agazzi and Company Inc.
|
Insurance Agent or Broker |
$1,390 |
$0 |
|
Clifton Gunderson LLP
3077 West Jefferson Street, Ste 105
Joliet,
IL
60435
|
Third Party Administrator |
$0 |
$257 |
TPA FEES |
|
| |
| Type of Contract |
Group Deferred Annuity |
| 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 |
Guaranteed Investment
|
| Balance at the end of the previous year |
$37,838 |
|
Additions |
$7,993 |
| Contributions Deposited during the year |
$6,982 |
| Dividends and credits |
$0 |
| Interest credited during the year |
$1,011 |
| Transferred from separate account |
$0 |
| Other |
$0 |
|
| Total of Balance and Additions |
$45,831 |
|
Deductions |
$389 |
| Disbursed from fund to pay benefits or purchase annuities during the year |
$0 |
| Administration charge made by carrier |
$389 |
| Transferred to Separate Account |
$0 |
| Other |
$0 |
|
| Balance at the end of the current year |
$45,442 |
|
|
