| EIN |
39-0989781 |
| Industry Code |
86231 |
| Contract Number |
992066-000 |
| Contract Year |
01/01/2010 — 12/31/2010 |
| Value in General Account at Year End |
$0 |
| Value in Separate Accounts at Year End |
$11,587,710 |
| |
| |
| Agent/Broker |
Organization Code |
Commissions Paid |
Fees Paid |
Purpose of Fees Paid |
Neil Simons
Jhw Financial Services
San Rafeal,
CA
94903
|
Insurance Agent or Broker |
$27,138 |
$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 |
STABLE VALUE OPTION
|
| Balance at the end of the previous year |
$627,462 |
|
Additions |
$372,563 |
| Contributions Deposited during the year |
$92,269 |
| Dividends and credits |
$0 |
| Interest credited during the year |
$18,849 |
| Transferred from separate account |
$260,207 |
| Other |
$1,238 |
|
| Total of Balance and Additions |
$1,000,025 |
|
Deductions |
$221,930 |
| Disbursed from fund to pay benefits or purchase annuities during the year |
$20,438 |
| Administration charge made by carrier |
$856 |
| Transferred to Separate Account |
$174,270 |
| Other |
$26,366 |
|
| Balance at the end of the current year |
$778,095 |
|
|
