| EIN |
04-1590850 |
| Industry Code |
65935 |
| Contract Number |
RM 83634-1 |
| Contract Year |
01/01/2010 — 12/31/2010 |
| Value in General Account at Year End |
$0 |
| Value in Separate Accounts at Year End |
$9,900,300 |
| |
| |
| Agent/Broker |
Organization Code |
Commissions Paid |
Fees Paid |
Purpose of Fees Paid |
David E Keller
901 Marquette Ave Ste 2600
Minneapolis,
MN
55402
|
Insurance Agent or Broker |
$18,256 |
$0 |
|
Robert A Skartvedt
121 S 8th Street Ste 630
Minneapolis,
MN
55402
|
Insurance Agent or Broker |
$5,604 |
$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 |
GROUP ANNUITY CONTRACT
|
| Balance at the end of the previous year |
$0 |
|
Additions |
$339,633 |
| Contributions Deposited during the year |
$274,153 |
| Dividends and credits |
$0 |
| Interest credited during the year |
$0 |
| Transferred from separate account |
$0 |
| Other |
$65,480 |
|
| Total of Balance and Additions |
$339,633 |
|
Deductions |
$339,633 |
| Disbursed from fund to pay benefits or purchase annuities during the year |
$0 |
| Administration charge made by carrier |
$0 |
| Transferred to Separate Account |
$339,633 |
| Other |
$0 |
|
| Balance at the end of the current year |
$0 |
|
|
