Schedule A
- Row 1
- Filing Id
- 84037273473289
- Form Id
- 98652128
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 8020379273473030003
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 2
- Filing Id
- 84037273473289
- Form Id
- 98652130
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 8020379273473030005
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 3
- Filing Id
- 84037273473289
- Form Id
- 98652127
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 8020379273473030002
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 4
- Filing Id
- 84037273473289
- Form Id
- 98652129
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 8020379273473030004
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 5
- Filing Id
- 84037273473289
- Form Id
- 98652131
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 8020379273473030006
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 6
- Ins Carrier Name: MET LIFE
- Filing Id
- 84037273473289
- Form Id
- 98652128
- Schedule A EIN
- 55-0612551
- Schedule A Plan Num
- 001
- Schedule A Plan Year Begin Date
- 2008-01-01
- Schedule A Tax Period
- 20081231
- Ins Carrier Name
- MET LIFE
- Ins Carrier EIN
- 13-5581829
- Ins Carrier Naic Code
- 65978
- Ins Contract Num
- 550612551D1
- Ins Prsn Covered End of year Count
- 1
- Ins Policy From Date
- 2008-01-01
- Ins Policy To Date
- 2008-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $131,337
- Pension End of year Sep Account Amount
- $858,117
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pnsn Type Unalloc Cntrct I
- 1
- Pension End Prev Bal Amount
- $150,166
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $5,782
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $5,782
- Pension Total Bal Addn Amount
- $155,948
- Pension Bnfts Dsbrsd Amount
- $24,611
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $24,611
- Pension End of year Bal Amount
- $131,337
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $0
- Wlfr Acquis Cost Amount
- $0
- Row 7
- Ins Carrier Name: JOHN HANCOCK
- Filing Id
- 84037273473289
- Form Id
- 98652129
- Schedule A EIN
- 55-0612551
- Schedule A Plan Num
- 001
- Schedule A Plan Year Begin Date
- 2008-01-01
- Schedule A Tax Period
- 20081231
- Ins Carrier Name
- JOHN HANCOCK
- Ins Carrier EIN
- 04-1414660
- Ins Carrier Naic Code
- 65099
- Ins Contract Num
- 550612551D1
- Ins Prsn Covered End of year Count
- 1
- Ins Policy From Date
- 2008-01-01
- Ins Policy To Date
- 2008-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $1
- Pension End of year Sep Account Amount
- $858,117
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pnsn Type Unalloc Cntrct I
- 1
- Pension End Prev Bal Amount
- $20,622
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $221
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $221
- Pension Total Bal Addn Amount
- $20,843
- Pension Bnfts Dsbrsd Amount
- $20,842
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $20,842
- Pension End of year Bal Amount
- $1
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $0
- Wlfr Acquis Cost Amount
- $0
- Row 8
- Ins Carrier Name: AXA EQUITABLE LIFE INSURANCE COMPANY
- Filing Id
- 84037273473289
- Form Id
- 98652127
- Schedule A EIN
- 55-0612551
- Schedule A Plan Num
- 001
- Schedule A Plan Year Begin Date
- 2008-01-01
- Schedule A Tax Period
- 20081231
- Ins Carrier Name
- AXA EQUITABLE LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 13-5570651
- Ins Carrier Naic Code
- 62944
- Ins Contract Num
- 550612551D1
- Ins Prsn Covered End of year Count
- 1
- Ins Policy From Date
- 2008-01-01
- Ins Policy To Date
- 2008-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $858,117
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pnsn Type Unalloc Cntrct I
- 1
- Pension End Prev Bal Amount
- $43,929
- Pension Contribution Dep Amount
- $56,357
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $1,215
- Pension Transfer From Amount
- $77,469
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $135,041
- Pension Total Bal Addn Amount
- $178,970
- Pension Bnfts Dsbrsd Amount
- $5,706
- Pension Admin Chrg Amount
- $6
- Pension Transfer To Amount
- $55,981
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $61,693
- Pension End of year Bal Amount
- $117,277
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $0
- Wlfr Acquis Cost Amount
- $0
- Row 9
- Ins Carrier Name: PRINCIPAL LIFE INSURANCE COMPANY
- Filing Id
- 84037273473289
- Form Id
- 98652130
- Schedule A EIN
- 55-0612551
- Schedule A Plan Num
- 001
- Schedule A Plan Year Begin Date
- 2008-01-01
- Schedule A Tax Period
- 20081231
- Ins Carrier Name
- PRINCIPAL LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 42-0127290
- Ins Carrier Naic Code
- 61271
- Ins Contract Num
- 550612551D1
- Ins Prsn Covered End of year Count
- 1
- Ins Policy From Date
- 2008-01-01
- Ins Policy To Date
- 2008-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $170,951
- Pension End of year Sep Account Amount
- $858,117
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pnsn Type Unalloc Cntrct I
- 1
- Pension End Prev Bal Amount
- $182,908
- Pension Contribution Dep Amount
- $8
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $6,458
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $6,466
- Pension Total Bal Addn Amount
- $189,374
- Pension Bnfts Dsbrsd Amount
- $18,423
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $18,423
- Pension End of year Bal Amount
- $170,951
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $0
- Wlfr Acquis Cost Amount
- $0
- Row 10
- Ins Carrier Name: NEW YORK LIFE INSURANCE COMPANY
- Filing Id
- 84037273473289
- Form Id
- 98652131
- Schedule A EIN
- 55-0612551
- Schedule A Plan Num
- 001
- Schedule A Plan Year Begin Date
- 2008-01-01
- Schedule A Tax Period
- 20081231
- Ins Carrier Name
- NEW YORK LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 13-5582869
- Ins Carrier Naic Code
- 66915
- Ins Contract Num
- 550612551D1
- Ins Prsn Covered End of year Count
- 1
- Ins Policy From Date
- 2008-01-01
- Ins Policy To Date
- 2008-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $93,685
- Pension End of year Sep Account Amount
- $858,117
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pnsn Type Unalloc Cntrct I
- 1
- Pension End Prev Bal Amount
- $120,999
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $4,381
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $4,381
- Pension Total Bal Addn Amount
- $125,380
- Pension Bnfts Dsbrsd Amount
- $31,689
- Pension Admin Chrg Amount
- $6
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $31,695
- Pension End of year Bal Amount
- $93,685
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $0
- Wlfr Acquis Cost Amount
- $0