| EIN |
01-0233346 |
| Industry Code |
65838 |
| Contract Number |
25179 |
| Contract Year |
01/01/2010 — 12/31/2010 |
| Value in General Account at Year End |
$35,888 |
| Value in Separate Accounts at Year End |
$4,201,058 |
| |
| |
| Agent/Broker |
Organization Code |
Commissions Paid |
Fees Paid |
Purpose of Fees Paid |
Fsc Agency, Inc.
3737 Woodland Ave
West Des Moines,
IA
50266
|
Agent or Broker other than Insurance |
$11,150 |
$0 |
|
Qualified Plan Consultants, LLC
4348 114th St
Des Moines,
IA
50322
|
Third Party Administrator |
$0 |
$1,930 |
TPA SERVICES |
|
| |
| 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 |
$45,443 |
|
Additions |
$8,544 |
| Contributions Deposited during the year |
$4,172 |
| Dividends and credits |
$0 |
| Interest credited during the year |
$778 |
| Transferred from separate account |
$0 |
| Other |
$3,594 |
|
| Total of Balance and Additions |
$53,987 |
|
Deductions |
$25,317 |
| Disbursed from fund to pay benefits or purchase annuities during the year |
$0 |
| Administration charge made by carrier |
$38 |
| Transferred to Separate Account |
$25,261 |
| Other |
$18 |
|
| Balance at the end of the current year |
$28,670 |
|
|
