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UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 401k Plan overview

Plan NameUPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN
Plan identification number 001

UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN Benefits

401k Plan TypeDefined 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.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • 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.

401k Sponsoring company profile

UPPERCASE LIVING, LLC has sponsored the creation of one or more 401k plans.

Company Name:UPPERCASE LIVING, LLC
Employer identification number (EIN):204035321
NAIC Classification:454390
NAIC Description:Other Direct Selling Establishments

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012016-01-01CASSIE JENSEN
0012015-01-01CASSIE JENSEN CASSIE JENSEN2016-07-06
0012014-01-01CASSIE JENSEN CASSIE JENSEN2015-10-09
0012013-01-01CASSIE JENSEN CASSIE JENSEN2014-07-30
0012012-01-01JEFFREY ERICKSON2013-09-23
0012011-01-01JEFF ERICKSON
0012010-01-01JEFF ERICKSON
0012009-01-01R. JASON BURTON

Plan Statistics for UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN

401k plan membership statisitcs for UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN

Measure Date Value
2016: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0125
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-010
Number of participants with account balances2016-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0126
Total number of active participants reported on line 7a of the Form 55002015-01-018
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0117
Total of all active and inactive participants2015-01-0125
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0125
Number of participants with account balances2015-01-0122
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0135
Total number of active participants reported on line 7a of the Form 55002014-01-0111
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0115
Total of all active and inactive participants2014-01-0126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0126
Number of participants with account balances2014-01-0124
2013: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0147
Total number of active participants reported on line 7a of the Form 55002013-01-0134
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0117
Total of all active and inactive participants2013-01-0151
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0151
Number of participants with account balances2013-01-0126
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2011: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01108
Total number of active participants reported on line 7a of the Form 55002011-01-0163
Number of retired or separated participants receiving benefits2011-01-012
Number of other retired or separated participants entitled to future benefits2011-01-0112
Total of all active and inactive participants2011-01-0177
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0177
Number of participants with account balances2011-01-0134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01141
Total number of active participants reported on line 7a of the Form 55002010-01-0181
Number of retired or separated participants receiving benefits2010-01-016
Number of other retired or separated participants entitled to future benefits2010-01-0111
Total of all active and inactive participants2010-01-0198
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0198
Number of participants with account balances2010-01-0148
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01132
Total number of active participants reported on line 7a of the Form 55002009-01-0184
Number of retired or separated participants receiving benefits2009-01-012
Number of other retired or separated participants entitled to future benefits2009-01-0119
Total of all active and inactive participants2009-01-01105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01105
Number of participants with account balances2009-01-0164
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN

Measure Date Value
2016 : UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-12-31$752
Expenses. Total of all expenses incurred2016-12-31$101,520
Benefits paid (including direct rollovers)2016-12-31$99,949
Total plan assets at end of year2016-12-31$0
Total plan assets at beginning of year2016-12-31$100,768
Value of fidelity bond covering the plan2016-12-31$40,000
Other income received2016-12-31$752
Net income (gross income less expenses)2016-12-31$-100,768
Net plan assets at end of year (total assets less liabilities)2016-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$100,768
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$1,571
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$2,228
Expenses. Total of all expenses incurred2015-12-31$22,052
Benefits paid (including direct rollovers)2015-12-31$18,059
Total plan assets at end of year2015-12-31$100,768
Total plan assets at beginning of year2015-12-31$120,592
Value of fidelity bond covering the plan2015-12-31$40,000
Total contributions received or receivable from participants2015-12-31$5,219
Other income received2015-12-31$-2,991
Net income (gross income less expenses)2015-12-31$-19,824
Net plan assets at end of year (total assets less liabilities)2015-12-31$100,768
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$120,592
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$3,993
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-12-31$16,680
Expenses. Total of all expenses incurred2014-12-31$9,011
Benefits paid (including direct rollovers)2014-12-31$5,000
Total plan assets at end of year2014-12-31$120,592
Total plan assets at beginning of year2014-12-31$112,923
Value of fidelity bond covering the plan2014-12-31$40,000
Total contributions received or receivable from participants2014-12-31$9,644
Other income received2014-12-31$7,036
Net income (gross income less expenses)2014-12-31$7,669
Net plan assets at end of year (total assets less liabilities)2014-12-31$120,592
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$112,923
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$4,011
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-12-31$37,971
Expenses. Total of all expenses incurred2013-12-31$92,125
Benefits paid (including direct rollovers)2013-12-31$87,784
Total plan assets at end of year2013-12-31$112,923
Total plan assets at beginning of year2013-12-31$167,077
Value of fidelity bond covering the plan2013-12-31$40,000
Total contributions received or receivable from participants2013-12-31$12,992
Other income received2013-12-31$24,979
Net income (gross income less expenses)2013-12-31$-54,154
Net plan assets at end of year (total assets less liabilities)2013-12-31$112,923
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$167,077
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$4,341
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2011 : UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$179
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$11,740
Total income from all sources (including contributions)2011-12-31$19,174
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$52,875
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$51,924
Value of total corrective distributions2011-12-31$178
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$27,773
Value of total assets at end of year2011-12-31$320,841
Value of total assets at beginning of year2011-12-31$366,103
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$773
Total interest from all sources2011-12-31$5
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 year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$40,000
If this is an individual account plan, was there a blackout period2011-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$27,258
Participant contributions at end of year2011-12-31$1,014
Participant contributions at beginning of year2011-12-31$1,740
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$179
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$11,740
Administrative expenses (other) incurred2011-12-31$773
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Income. Non cash contributions2011-12-31$515
Value of net income/loss2011-12-31$-33,701
Value of net assets at end of year (total assets less liabilities)2011-12-31$320,662
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$354,363
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$303,339
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$358,814
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$16,488
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$5,549
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$5,549
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$5
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-8,604
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$51,924
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31TANNER LLC
Accountancy firm EIN2011-12-31202253036
2010 : UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$11,740
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$153,411
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$103,910
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$92,170
Value of total corrective distributions2010-12-31$11,740
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$110,578
Value of total assets at end of year2010-12-31$366,103
Value of total assets at beginning of year2010-12-31$304,862
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$0
Total interest from all sources2010-12-31$5
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$4,985
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$4,985
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$40,000
If this is an individual account plan, was there a blackout period2010-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$52,290
Participant contributions at end of year2010-12-31$1,740
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$43,457
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$11,740
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$49,501
Value of net assets at end of year (total assets less liabilities)2010-12-31$354,363
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$304,862
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$358,814
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$304,862
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$5,549
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$5
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$37,843
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$14,831
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$92,170
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31LAKE, HILL & MEYERS
Accountancy firm EIN2010-12-31870491579
2009 : UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN

2016: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingYes
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2011: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2010: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement - TrustYes
2009: UPPERCASE LIVING, LLC 401(K) & PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number105584
Policy instance 1
Insurance contract or identification number105584
Number of Individuals Covered22
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,182
Total amount of fees paid to insurance companyUSD $70
Commission paid to Insurance BrokerUSD $591
Insurance broker organization code?3
Amount paid for insurance broker fees70
Additional information about fees paid to insurance brokerADMINISTRATION FEE
Insurance broker nameWC ADMINISTRATORS LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number105584
Policy instance 1
Insurance contract or identification number105584
Number of Individuals Covered24
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,154
Total amount of fees paid to insurance companyUSD $70
Commission paid to Insurance BrokerUSD $577
Insurance broker organization code?3
Amount paid for insurance broker fees70
Additional information about fees paid to insurance brokerADMINISTRATION FEE
Insurance broker nameWC ADMINISTRATORS LLC
JOHN HANCOCK LIFE INSURANCE COMPANY (U.S.A.) (National Association of Insurance Commissioners NAIC id number: 65838 )
Policy contract number105584
Policy instance 1
Insurance contract or identification number105584
Number of Individuals Covered26
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,338
Total amount of fees paid to insurance companyUSD $350
Commission paid to Insurance BrokerUSD $767
Insurance broker organization code?3
Amount paid for insurance broker fees245
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker nameCOOK MARTEN POULSON & ASSOC

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