| EIN |
31-4156830 |
| Industry Code |
66869 |
| Contract Number |
164-70306 |
| Contract Year |
01/01/2009 — 12/31/2010 |
| Value in General Account at Year End |
$533,043 |
| Value in Separate Accounts at Year End |
$3,513,537 |
| |
| |
| Agent/Broker |
Organization Code |
Commissions Paid |
Fees Paid |
Purpose of Fees Paid |
Lpl Financial Corporation
9785 Towne Centre Drive
San Diego,
CA
92121
|
Insurance Agent or Broker |
$2,371 |
$0 |
|
Senex Insurance Services
21021 Ventura Blvd., Suite 310
Woodland Hills,
CA
91364
|
Third Party Administrator |
$0 |
$593 |
|
|
| |
| 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 |
$546,036 |
|
Additions |
$195,469 |
| Contributions Deposited during the year |
$24,803 |
| Dividends and credits |
$0 |
| Interest credited during the year |
$2,133 |
| Transferred from separate account |
$164,438 |
| Other |
$4,095 |
|
| Total of Balance and Additions |
$741,505 |
|
Deductions |
$208,462 |
| Disbursed from fund to pay benefits or purchase annuities during the year |
$0 |
| Administration charge made by carrier |
$91 |
| Transferred to Separate Account |
$195,943 |
| Other |
$12,428 |
|
| Balance at the end of the current year |
$533,043 |
|
|
