| EIN |
71-0294708 |
| Industry Code |
86509 |
| Contract Number |
PHA328 |
| Contract Year |
01/01/2010 — 12/31/2010 |
| Value in General Account at Year End |
$1,101,572 |
| Value in Separate Accounts at Year End |
$2,697,657 |
| |
| |
| Agent/Broker |
Organization Code |
Commissions Paid |
Fees Paid |
Purpose of Fees Paid |
David Klugmann
506 Ridge Ct
Lakewood,
NJ
08701
|
Insurance Agent or Broker |
$14,208 |
$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 PENSION FUNDING
|
| Balance at the end of the previous year |
$850,473 |
|
Additions |
$1,403,016 |
| Contributions Deposited during the year |
$384,712 |
| Dividends and credits |
$0 |
| Interest credited during the year |
$28,570 |
| Transferred from separate account |
$887,672 |
| Other |
$102,062 |
|
| Total of Balance and Additions |
$2,253,489 |
|
Deductions |
$1,151,917 |
| Disbursed from fund to pay benefits or purchase annuities during the year |
$366,268 |
| Administration charge made by carrier |
$0 |
| Transferred to Separate Account |
$652,642 |
| Other |
$133,007 |
|
| Balance at the end of the current year |
$1,101,572 |
|
|
