| EIN |
84-0467907 |
| Industry Code |
68322 |
| Contract Number |
937825-01 |
| Contract Year |
01/01/2010 — 12/31/2010 |
| Value in General Account at Year End |
$287,559 |
| Value in Separate Accounts at Year End |
$3,002,410 |
| |
| |
| Agent/Broker |
Organization Code |
Commissions Paid |
Fees Paid |
Purpose of Fees Paid |
Cs Financial Group, Inc.
7334 N Riley Ave
Indianapolis,
IN
46250
|
Insurance Agent or Broker |
$13,315 |
$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 VARIABLE ANNUITY CONTRACT
|
| Balance at the end of the previous year |
$219,910 |
|
Additions |
$217,102 |
| Contributions Deposited during the year |
$13,584 |
| Dividends and credits |
$0 |
| Interest credited during the year |
$5,495 |
| Transferred from separate account |
$195,385 |
| Other |
$2,638 |
|
| Total of Balance and Additions |
$437,012 |
|
Deductions |
$149,453 |
| Disbursed from fund to pay benefits or purchase annuities during the year |
$77,148 |
| Administration charge made by carrier |
$469 |
| Transferred to Separate Account |
$71,836 |
| Other |
$0 |
|
| Balance at the end of the current year |
$287,559 |
|
|
