401k Plan data: CUSA GCT, LLC plan

CUSA GCT, LLC 401k Plan overview

Plan Name	CUSA GCT, LLC
Plan identification number	001

CUSA GCT, LLC Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

CUSA GCT, LLC has sponsored the creation of one or more 401k plans.

Company Name: CUSA GCT, LLC

Employer identification number (EIN): 200151833

NAIC Classification: 485990

Additional information about CUSA GCT, LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations

Incorporation Date:

Company Identification Number: 3692570

More information about CUSA GCT, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CUSA GCT, LLC

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2014-01-01 BRIAN CEJKA 2014-09-23
001 2013-01-01 BRIAN CEJKA 2014-07-03
001 2012-01-01 BRIAN CEJKA
001 2011-01-01 RANDY RHODES
001 2010-01-01 RANDY RHODES
001 2009-01-01 RANDY RHODES RANDY RHODES 2010-10-13

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2014-01-01	BRIAN CEJKA	2014-09-23
001	2013-01-01	BRIAN CEJKA	2014-07-03
001	2012-01-01	BRIAN CEJKA
001	2011-01-01	RANDY RHODES
001	2010-01-01	RANDY RHODES
001	2009-01-01	RANDY RHODES		RANDY RHODES	2010-10-13

Plan Statistics for CUSA GCT, LLC

401k plan membership statisitcs for CUSA GCT, LLC

Measure Date Value
2012: CUSA GCT, LLC 2012 401k membership
Total participants, beginning-of-year 2012-01-01 114
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 2
Number of retired or separated participants receiving benefits 2012-01-01 1
Number of other retired or separated participants entitled to future benefits 2012-01-01 14
Total of all active and inactive participants 2012-01-01 17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 1
Total participants 2012-01-01 18
Number of participants with account balances 2012-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 3
2011: CUSA GCT, LLC 2011 401k membership
Total participants, beginning-of-year 2011-01-01 121
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 104
Number of retired or separated participants receiving benefits 2011-01-01 1
Number of other retired or separated participants entitled to future benefits 2011-01-01 5
Total of all active and inactive participants 2011-01-01 110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 1
Total participants 2011-01-01 111
Number of participants with account balances 2011-01-01 41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 2
2010: CUSA GCT, LLC 2010 401k membership
Total participants, beginning-of-year 2010-01-01 116
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 112
Number of retired or separated participants receiving benefits 2010-01-01 1
Number of other retired or separated participants entitled to future benefits 2010-01-01 3
Total of all active and inactive participants 2010-01-01 116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 1
Total participants 2010-01-01 117
Number of participants with account balances 2010-01-01 33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 3
2009: CUSA GCT, LLC 2009 401k membership
Total participants, beginning-of-year 2009-01-01 141
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 107
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 4
Total of all active and inactive participants 2009-01-01 111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 111
Number of participants with account balances 2009-01-01 31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2012: CUSA GCT, LLC 2012 401k membership
Total participants, beginning-of-year	2012-01-01	114
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	2
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	14
Total of all active and inactive participants	2012-01-01	17
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	18
Number of participants with account balances	2012-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	3
2011: CUSA GCT, LLC 2011 401k membership
Total participants, beginning-of-year	2011-01-01	121
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	104
Number of retired or separated participants receiving benefits	2011-01-01	1
Number of other retired or separated participants entitled to future benefits	2011-01-01	5
Total of all active and inactive participants	2011-01-01	110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	111
Number of participants with account balances	2011-01-01	41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	2
2010: CUSA GCT, LLC 2010 401k membership
Total participants, beginning-of-year	2010-01-01	116
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	112
Number of retired or separated participants receiving benefits	2010-01-01	1
Number of other retired or separated participants entitled to future benefits	2010-01-01	3
Total of all active and inactive participants	2010-01-01	116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	1
Total participants	2010-01-01	117
Number of participants with account balances	2010-01-01	33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	3
2009: CUSA GCT, LLC 2009 401k membership
Total participants, beginning-of-year	2009-01-01	141
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	107
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	4
Total of all active and inactive participants	2009-01-01	111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	111
Number of participants with account balances	2009-01-01	31
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on CUSA GCT, LLC

Measure	Date	Value
2012 : CUSA GCT, LLC 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$0
Total income from all sources (including contributions)	2012-12-31	$93,490
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$362,631
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$361,140
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$59,972
Value of total assets at end of year	2012-12-31	$131,839
Value of total assets at beginning of year	2012-12-31	$400,980
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$1,491
Total interest from all sources	2012-12-31	$2,041
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2012-12-31	$0
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$43,528
Participant contributions at end of year	2012-12-31	$14,857
Participant contributions at beginning of year	2012-12-31	$61,857
Participant contributions at beginning of year	2012-12-31	$2,518
Other income not declared elsewhere	2012-12-31	$1,049
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$-269,141
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$131,839
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$400,980
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in pooled separate accounts at end of year	2012-12-31	$94,745
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$276,207
Interest on participant loans	2012-12-31	$2,041
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$22,237
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$59,470
Net investment gain/loss from pooled separate accounts	2012-12-31	$30,428
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$16,444
Employer contributions (assets) at beginning of year	2012-12-31	$928
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$361,140
Contract administrator fees	2012-12-31	$1,491
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2012-12-31	Disclaimer
Accountancy firm name	2012-12-31	FARMER, FUQUA & HUFF, P.C.
Accountancy firm EIN	2012-12-31	752599166
2011 : CUSA GCT, LLC 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$0
Total income from all sources (including contributions)	2011-12-31	$74,177
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$24,255
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$21,844
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$79,764
Value of total assets at end of year	2011-12-31	$400,980
Value of total assets at beginning of year	2011-12-31	$351,058
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$2,411
Total interest from all sources	2011-12-31	$1,551
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$57,292
Participant contributions at end of year	2011-12-31	$61,857
Participant contributions at beginning of year	2011-12-31	$37,349
Participant contributions at end of year	2011-12-31	$2,518
Participant contributions at beginning of year	2011-12-31	$1,897
Other income not declared elsewhere	2011-12-31	$1,453
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$49,922
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$400,980
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$351,058
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in pooled separate accounts at end of year	2011-12-31	$276,207
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$262,330
Interest on participant loans	2011-12-31	$1,551
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$59,470
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$48,689
Net investment gain/loss from pooled separate accounts	2011-12-31	$-8,591
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$22,472
Employer contributions (assets) at end of year	2011-12-31	$928
Employer contributions (assets) at beginning of year	2011-12-31	$793
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$21,844
Contract administrator fees	2011-12-31	$2,411
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2011-12-31	Disclaimer
Accountancy firm name	2011-12-31	FARMER, FUQUA & HUFF, P.C.
Accountancy firm EIN	2011-12-31	752599166
2010 : CUSA GCT, LLC 2010 401k financial data
Total unrealized appreciation/depreciation of assets	2010-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$0
Total income from all sources (including contributions)	2010-12-31	$115,702
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$82,333
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$80,494
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$76,719
Value of total assets at end of year	2010-12-31	$351,058
Value of total assets at beginning of year	2010-12-31	$317,689
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$1,839
Total interest from all sources	2010-12-31	$2,443
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$5,000,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$55,051
Participant contributions at end of year	2010-12-31	$37,349
Participant contributions at beginning of year	2010-12-31	$48,627
Participant contributions at end of year	2010-12-31	$1,897
Participant contributions at beginning of year	2010-12-31	$2,176
Other income not declared elsewhere	2010-12-31	$1,905
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$33,369
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$351,058
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$317,689
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in pooled separate accounts at end of year	2010-12-31	$262,330
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$199,462
Interest on participant loans	2010-12-31	$2,443
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$48,689
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$66,580
Net investment gain/loss from pooled separate accounts	2010-12-31	$34,635
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$21,668
Employer contributions (assets) at end of year	2010-12-31	$793
Employer contributions (assets) at beginning of year	2010-12-31	$844
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$80,494
Contract administrator fees	2010-12-31	$1,839
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2010-12-31	Disclaimer
Accountancy firm name	2010-12-31	FARMER, FUQUA & HUFF, P.C.
Accountancy firm EIN	2010-12-31	752599166
2009 : CUSA GCT, LLC 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 CUSA GCT, LLC

2012: CUSA GCT, LLC 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	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: CUSA GCT, LLC 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	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: CUSA GCT, LLC 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	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: CUSA GCT, LLC 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	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

341377

Policy instance

Insurance contract or identification number	341377
Number of Individuals Covered	18
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $588
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
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
Commission paid to Insurance Broker	USD $233
Insurance broker organization code?	3
Insurance broker name	UBS FINANCIAL SERVICES

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

341377

Policy instance

Insurance contract or identification number	341377
Number of Individuals Covered	111
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $681
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
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

TRANSAMERICA FINANCIAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70688 )

Policy contract number

341377

Policy instance

Insurance contract or identification number	341377
Number of Individuals Covered	117
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $600
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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
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

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Company Name:	CUSA GCT, LLC
Employer identification number (EIN):	200151833
NAIC Classification:	485990

Jurisdiction of Incorporation:	State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number:	3692570