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Company:
P.O.Y. Holdings, Inc.

Plan:
P.O.Y. Holdings, Inc. 401k Savings Plan
 
Form 5500 | Insurance Information
Insurance Carrier Summary Persons Covered
 
Hartford Life Insurance Company 158
EIN 06-0974148
Industry Code 88072
Contract Number GA-802936
Contract Year 01/01/2010 — 12/31/2010
Value in General Account at Year End $0
Value in Separate Accounts at Year End $3,639,365
 
Insurance Fees and Commissions $9,316
 
Persons Receiving Commissions and Fees  
Agent/Broker Organization Code Commissions Paid Fees Paid Purpose of Fees Paid
Merrill Lynch Life Agency
1215 4th Avenue 26Thfl
Seattle, WA 98161
Insurance Agent or Broker $9,316 $0
 
Allocated Funds  
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
 
Unallocated Funds  
Type of Contract GROUP ANNUITY CONTRACT
Balance at the end of the previous year $0
Additions $0
Contributions Deposited during the year $0
Dividends and credits $0
Interest credited during the year $0
Transferred from separate account $0
Other $0
Total of Balance and Additions $0
Deductions $0
Disbursed from fund to pay benefits or purchase annuities during the year $0
Administration charge made by carrier $0
Transferred to Separate Account $0
Other $0
Balance at the end of the current year $0