| EIN |
01-0233346 |
| Industry Code |
65838 |
| Contract Number |
47175 |
| Contract Year |
01/01/2010 — 12/31/2010 |
| Value in General Account at Year End |
$13,774 |
| Value in Separate Accounts at Year End |
$5,534,446 |
| |
| |
| Agent/Broker |
Organization Code |
Commissions Paid |
Fees Paid |
Purpose of Fees Paid |
Jw Cole Insurance Services, Inc.
6928 W Linebaugh Ave Suite 101
Tampa,
FL
33625
|
Insurance Agent or Broker |
$22,725 |
$0 |
|
Lba Retirement Plan Services, LLC
501 Riverside Avenue Suite 800
Jacksonville,
FL
32202
|
Third Party Administrator |
$0 |
$9,650 |
TRANSACTION BASED FEES |
Lba Retirement Plan Services, LLC
501 Riverside Avenue Sutie 800
Jacksonville,
FL
32202
|
Third Party Administrator |
$0 |
$1,980 |
TPA FORUM COMPENSATION |
Vanguard Group, Inc.
100 Vanguard Blvd
Malvern,
PA
19355
|
Investment Manager/Adviser |
$0 |
$6 |
REDEMPTION FEES |
|
| |
| 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 |
$9,448 |
|
Additions |
$4,386 |
| Contributions Deposited during the year |
$4,652 |
| Dividends and credits |
$0 |
| Interest credited during the year |
$290 |
| Transferred from separate account |
$0 |
| Other |
$-556 |
|
| Total of Balance and Additions |
$13,834 |
|
Deductions |
$60 |
| Disbursed from fund to pay benefits or purchase annuities during the year |
$0 |
| Administration charge made by carrier |
$0 |
| Transferred to Separate Account |
$60 |
| Other |
$0 |
|
| Balance at the end of the current year |
$13,774 |
|
|
