401k Plan data: NELSON R. DEMILLE DEFINED BENEFIT PLAN plan

NELSON R. DEMILLE DEFINED BENEFIT PLAN 401k Plan overview

Plan Name	NELSON R. DEMILLE DEFINED BENEFIT PLAN
Plan identification number	002

NELSON R. DEMILLE DEFINED BENEFIT PLAN Benefits

401k Plan Type

Defined Benefit Pension

Plan Features/Benefits

Benefits are primarily pay related
Covered by PBGC - Plan is covered under the PBGC insurance program (see ERISA section 4021).
Plan covered by PBGC that was terminated and closed out for PBGC purposes - Before the end of the plan year (or a prior plan year), (1) the plan terminated in a standard (or distress) termination and completed the distribution of plan assets in satisfaction of all benefit liabilities (or all ERISA Title IV benefits for distress termination); or (2) a trustee was appointed for a terminated plan pursuant to ERISA section 4042.
Frozen Plan - As of the last day of the plan year, the plan provides that no participant will get any new benefit accrual (whether because of service or compensation).
Plan covering Self-Employed individuals.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
Life insurance

401k Sponsoring company profile

NELSON R. DEMILLE has sponsored the creation of one or more 401k plans.

Company Name: NELSON R. DEMILLE

Employer identification number (EIN): 112701098

NAIC Classification: 711510
NAIC Description: Independent Artists, Writers, and Performers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NELSON R. DEMILLE DEFINED BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2013-01-01 NELSON R. DEMILLE
002 2012-01-01 NELSON R. DEMILLE
002 2011-01-01 NELSON R. DEMILLE
002 2010-01-01 NELSON R. DEMILLE
002 2009-01-01 NELSON R. DEMILLE

Plan id#	Filing Submission Date	Name of Administrator
002	2013-01-01	NELSON R. DEMILLE
002	2012-01-01	NELSON R. DEMILLE
002	2011-01-01	NELSON R. DEMILLE
002	2010-01-01	NELSON R. DEMILLE
002	2009-01-01	NELSON R. DEMILLE

Plan Statistics for NELSON R. DEMILLE DEFINED BENEFIT PLAN

401k plan membership statisitcs for NELSON R. DEMILLE DEFINED BENEFIT PLAN

Measure Date Value
2013: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 0
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 0
2012: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 4
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 4
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 4
2010: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 3
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 3
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 4
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 4
Number of retired or separated participants receiving benefits 2009-01-01 0
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2013: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	0
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	0
2012: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	4
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	4
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	4
2010: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	3
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	3
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	3
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	3
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	4
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	4
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	0
Total of all active and inactive participants	2009-01-01	4
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	4
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on NELSON R. DEMILLE DEFINED BENEFIT PLAN

Measure	Date	Value
2013 : NELSON R. DEMILLE DEFINED BENEFIT PLAN 2013 401k financial data
Transfers to/from the plan	2013-10-31	$0
Total plan liabilities at end of year	2013-10-31	$0
Total plan liabilities at beginning of year	2013-10-31	$0
Total income from all sources	2013-10-31	$132,256
Expenses. Total of all expenses incurred	2013-10-31	$1,818,058
Benefits paid (including direct rollovers)	2013-10-31	$1,818,058
Total plan assets at end of year	2013-10-31	$0
Total plan assets at beginning of year	2013-10-31	$1,685,802
Value of fidelity bond covering the plan	2013-10-31	$172,000
Total contributions received or receivable from participants	2013-10-31	$0
Expenses. Other expenses not covered elsewhere	2013-10-31	$0
Contributions received from other sources (not participants or employers)	2013-10-31	$0
Other income received	2013-10-31	$57,256
Noncash contributions received	2013-10-31	$0
Net income (gross income less expenses)	2013-10-31	$-1,685,802
Net plan assets at end of year (total assets less liabilities)	2013-10-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2013-10-31	$1,685,802
Total contributions received or receivable from employer(s)	2013-10-31	$75,000
Value of certain deemed distributions of participant loans	2013-10-31	$0
Value of corrective distributions	2013-10-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-10-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-10-31	$0
2012 : NELSON R. DEMILLE DEFINED BENEFIT PLAN 2012 401k financial data
Transfers to/from the plan	2012-12-31	$0
Total plan liabilities at end of year	2012-12-31	$0
Total plan liabilities at beginning of year	2012-12-31	$0
Total income from all sources	2012-12-31	$214,518
Expenses. Total of all expenses incurred	2012-12-31	$7,583
Benefits paid (including direct rollovers)	2012-12-31	$0
Total plan assets at end of year	2012-12-31	$1,685,802
Total plan assets at beginning of year	2012-12-31	$1,478,867
Value of fidelity bond covering the plan	2012-12-31	$172,000
Total contributions received or receivable from participants	2012-12-31	$0
Expenses. Other expenses not covered elsewhere	2012-12-31	$7,583
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$144,518
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$206,935
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,685,802
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,478,867
Assets. Value of participant loans	2012-12-31	$0
Total contributions received or receivable from employer(s)	2012-12-31	$70,000
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : NELSON R. DEMILLE DEFINED BENEFIT PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$0
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$90,918
Expenses. Total of all expenses incurred	2011-12-31	$1,431
Benefits paid (including direct rollovers)	2011-12-31	$0
Total plan assets at end of year	2011-12-31	$1,478,867
Total plan assets at beginning of year	2011-12-31	$1,389,380
Value of fidelity bond covering the plan	2011-12-31	$175,000
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$1,431
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$20,918
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$89,487
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,478,867
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,389,380
Total contributions received or receivable from employer(s)	2011-12-31	$70,000
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$0
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : NELSON R. DEMILLE DEFINED BENEFIT PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$254,160
Expenses. Total of all expenses incurred	2010-12-31	$1,767,286
Benefits paid (including direct rollovers)	2010-12-31	$1,750,000
Total plan assets at end of year	2010-12-31	$1,389,380
Total plan assets at beginning of year	2010-12-31	$2,902,506
Value of fidelity bond covering the plan	2010-12-31	$175,000
Total contributions received or receivable from participants	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$154,160
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$-1,513,126
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,389,380
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$2,902,506
Total contributions received or receivable from employer(s)	2010-12-31	$100,000
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$17,286
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : NELSON R. DEMILLE DEFINED BENEFIT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for NELSON R. DEMILLE DEFINED BENEFIT PLAN

2013: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	Yes
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: NELSON R. DEMILLE DEFINED BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )

Policy contract number

M52460 & 5LW

Policy instance

Insurance contract or identification number	M52460 & 5LW
Number of Individuals Covered	0
Insurance policy start date	2013-01-01
Insurance policy end date	2013-10-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	THOMAS ESCHMANN

PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )

Policy contract number

M52460 & 5LW

Policy instance

Insurance contract or identification number	M52460 & 5LW
Number of Individuals Covered	2
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $233
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $170
Amount paid for insurance broker fees	0
Additional information about fees paid to insurance broker	N/A
Insurance broker organization code?	3
Insurance broker name	THOMAS ESCHMANN

PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )

Policy contract number

IND. CONTRACTS

Policy instance

Insurance contract or identification number	IND. CONTRACTS
Number of Individuals Covered	2
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $1,431
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )

Policy contract number

IND. CONTRACTS

Policy instance

Insurance contract or identification number	IND. CONTRACTS
Number of Individuals Covered	2
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $9,014
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Insurance broker name	NOT READILY AVAILABLE

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Company Name:	NELSON R. DEMILLE
Employer identification number (EIN):	112701098
NAIC Classification:	711510
NAIC Description:	Independent Artists, Writers, and Performers