| EIN |
01-0233346 |
| Industry Code |
65838 |
| Contract Number |
17257 |
| Contract Year |
07/01/2009 — 06/30/2010 |
| Value in General Account at Year End |
$0 |
| Value in Separate Accounts at Year End |
$2,055,326 |
| |
| |
| Agent/Broker |
Organization Code |
Commissions Paid |
Fees Paid |
Purpose of Fees Paid |
Polycomp Administrative Services
6400 Canoga Ave., Suite 250
Woodland Hills,
CA
91367
|
Third Party Administrator |
$0 |
$7,017 |
TPA PROCESSING FEES |
Financial Telesis, Inc.
4340 Redwood Highway, Suite A-23
San Rafael,
CA
94903
|
Insurance Agent or Broker |
$6,044 |
$0 |
|
Polycomp Administrative Services
6400 Canoga Ave., Suite 250
Woodland Hills,
CA
91367
|
Third Party Administrator |
$893 |
$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 |
Guaranteed Investment
|
| Balance at the end of the previous year |
$63,833 |
|
Additions |
$21,089 |
| Contributions Deposited during the year |
$6,028 |
| Dividends and credits |
$0 |
| Interest credited during the year |
$1,669 |
| Transferred from separate account |
$11,463 |
| Other |
$1,929 |
|
| Total of Balance and Additions |
$84,922 |
|
Deductions |
$6,294 |
| Disbursed from fund to pay benefits or purchase annuities during the year |
$0 |
| Administration charge made by carrier |
$516 |
| Transferred to Separate Account |
$3,068 |
| Other |
$2,710 |
|
| Balance at the end of the current year |
$78,628 |
|
|
