401k Plan data: LUSK & COMPANY PROFIT SHARING 401(K) PLAN plan

LUSK & COMPANY PROFIT SHARING 401(K) PLAN 401k Plan overview

Plan Name	LUSK & COMPANY PROFIT SHARING 401(K) PLAN
Plan identification number	001

LUSK & COMPANY PROFIT SHARING 401(K) PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.

401k Sponsoring company profile

LUSK & COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: LUSK & COMPANY, INC.

Employer identification number (EIN): 208450771

NAIC Classification: 314000
NAIC Description: Textile Product Mills

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LUSK & COMPANY PROFIT SHARING 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2017-01-01 ALLEN CALHOUN
001 2016-01-01 ALLEN CALHOUN
001 2015-01-01 ALLEN CALHOUN
001 2014-01-01 ALLEN CALHOUN
001 2013-01-01 ALLEN CALHOUN
001 2012-01-01 ALLEN CALHOUN
001 2011-01-01 ALLEN CALHOUN
001 2010-01-01 ALLEN CALHOUN
001 2009-01-01 WILLIAM C.LUSK

Plan id#	Filing Submission Date	Name of Administrator
001	2017-01-01	ALLEN CALHOUN
001	2016-01-01	ALLEN CALHOUN
001	2015-01-01	ALLEN CALHOUN
001	2014-01-01	ALLEN CALHOUN
001	2013-01-01	ALLEN CALHOUN
001	2012-01-01	ALLEN CALHOUN
001	2011-01-01	ALLEN CALHOUN
001	2010-01-01	ALLEN CALHOUN
001	2009-01-01	WILLIAM C.LUSK

Plan Statistics for LUSK & COMPANY PROFIT SHARING 401(K) PLAN

401k plan membership statisitcs for LUSK & COMPANY PROFIT SHARING 401(K) PLAN

Measure Date Value
2017: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 1
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
Total participants 2017-01-01 0
Number of participants with account balances 2017-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-01-01 0
2016: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 12
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 1
Total of all active and inactive participants 2016-01-01 1
Total participants 2016-01-01 1
Number of participants with account balances 2016-01-01 1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 13
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 12
Total of all active and inactive participants 2015-01-01 12
Total participants 2015-01-01 12
Number of participants with account balances 2015-01-01 12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 11
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 13
Total of all active and inactive participants 2014-01-01 13
Total participants 2014-01-01 13
Number of participants with account balances 2014-01-01 12
2013: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 8
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 11
Total of all active and inactive participants 2013-01-01 11
Total participants 2013-01-01 11
Number of participants with account balances 2013-01-01 11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 1
2012: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 15
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 8
Total of all active and inactive participants 2012-01-01 8
Total participants 2012-01-01 8
Number of participants with account balances 2012-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 7
2011: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 9
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 11
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 11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 11
Number of participants with account balances 2011-01-01 9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 10
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 9
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 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 9
Number of participants with account balances 2010-01-01 7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0
2009: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 14
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 9
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 9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 9
Number of participants with account balances 2009-01-01 8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2017: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	1
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
Total participants	2017-01-01	0
Number of participants with account balances	2017-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	0
2016: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	12
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	1
Total of all active and inactive participants	2016-01-01	1
Total participants	2016-01-01	1
Number of participants with account balances	2016-01-01	1
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	13
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	12
Total of all active and inactive participants	2015-01-01	12
Total participants	2015-01-01	12
Number of participants with account balances	2015-01-01	12
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	11
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	13
Total of all active and inactive participants	2014-01-01	13
Total participants	2014-01-01	13
Number of participants with account balances	2014-01-01	12
2013: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	8
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	11
Total of all active and inactive participants	2013-01-01	11
Total participants	2013-01-01	11
Number of participants with account balances	2013-01-01	11
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	1
2012: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	15
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	8
Total of all active and inactive participants	2012-01-01	8
Total participants	2012-01-01	8
Number of participants with account balances	2012-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	7
2011: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	9
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	11
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	11
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	11
Number of participants with account balances	2011-01-01	9
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	10
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	9
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	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	9
Number of participants with account balances	2010-01-01	7
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0
2009: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	14
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	9
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	9
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	9
Number of participants with account balances	2009-01-01	8
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on LUSK & COMPANY PROFIT SHARING 401(K) PLAN

Measure	Date	Value
2017 : LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2017 401k financial data
Transfers to/from the plan	2017-03-31	$-36,803
Total income from all sources	2017-03-31	$90
Total plan assets at end of year	2017-03-31	$0
Total plan assets at beginning of year	2017-03-31	$36,713
Value of fidelity bond covering the plan	2017-03-31	$250,000
Other income received	2017-03-31	$90
Net income (gross income less expenses)	2017-03-31	$90
Net plan assets at end of year (total assets less liabilities)	2017-03-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2017-03-31	$36,713
2016 : LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2016 401k financial data
Transfers to/from the plan	2016-12-31	$-967,759
Total income from all sources	2016-12-31	$146,409
Expenses. Total of all expenses incurred	2016-12-31	$12,277
Total plan assets at end of year	2016-12-31	$36,713
Total plan assets at beginning of year	2016-12-31	$870,340
Value of fidelity bond covering the plan	2016-12-31	$250,000
Total contributions received or receivable from participants	2016-12-31	$70,600
Contributions received from other sources (not participants or employers)	2016-12-31	$3,673
Other income received	2016-12-31	$72,136
Net income (gross income less expenses)	2016-12-31	$134,132
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$36,713
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$870,340
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$12,277
2015 : LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$74,052
Expenses. Total of all expenses incurred	2015-12-31	$27,296
Benefits paid (including direct rollovers)	2015-12-31	$22,394
Total plan assets at end of year	2015-12-31	$870,340
Total plan assets at beginning of year	2015-12-31	$823,584
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$62,601
Other income received	2015-12-31	$-19,475
Net income (gross income less expenses)	2015-12-31	$46,756
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$870,340
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$823,584
Total contributions received or receivable from employer(s)	2015-12-31	$30,926
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$4,902
2014 : LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$125,988
Expenses. Total of all expenses incurred	2014-12-31	$73,788
Benefits paid (including direct rollovers)	2014-12-31	$72,927
Total plan assets at end of year	2014-12-31	$823,584
Total plan assets at beginning of year	2014-12-31	$771,384
Value of fidelity bond covering the plan	2014-12-31	$500,000
Total contributions received or receivable from participants	2014-12-31	$57,772
Contributions received from other sources (not participants or employers)	2014-12-31	$246
Other income received	2014-12-31	$39,824
Net income (gross income less expenses)	2014-12-31	$52,200
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$823,584
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$771,384
Total contributions received or receivable from employer(s)	2014-12-31	$28,146
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$861
2013 : LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$130,796
Expenses. Total of all expenses incurred	2013-12-31	$27,062
Benefits paid (including direct rollovers)	2013-12-31	$27,062
Total plan assets at end of year	2013-12-31	$771,384
Total plan assets at beginning of year	2013-12-31	$667,650
Value of fidelity bond covering the plan	2013-12-31	$500,000
Total contributions received or receivable from participants	2013-12-31	$41,741
Contributions received from other sources (not participants or employers)	2013-12-31	$1,734
Other income received	2013-12-31	$65,055
Net income (gross income less expenses)	2013-12-31	$103,734
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$771,384
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$667,650
Total contributions received or receivable from employer(s)	2013-12-31	$22,266
2012 : LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$121,901
Expenses. Total of all expenses incurred	2012-12-31	$241,565
Benefits paid (including direct rollovers)	2012-12-31	$241,564
Total plan assets at end of year	2012-12-31	$667,650
Total plan assets at beginning of year	2012-12-31	$787,314
Value of fidelity bond covering the plan	2012-12-31	$250,000
Total contributions received or receivable from participants	2012-12-31	$35,865
Other income received	2012-12-31	$69,491
Net income (gross income less expenses)	2012-12-31	$-119,664
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$667,650
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$787,314
Total contributions received or receivable from employer(s)	2012-12-31	$16,545
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$1
2011 : LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$34,002
Expenses. Total of all expenses incurred	2011-12-31	$6,376
Benefits paid (including direct rollovers)	2011-12-31	$6,376
Total plan assets at end of year	2011-12-31	$787,314
Total plan assets at beginning of year	2011-12-31	$759,688
Value of fidelity bond covering the plan	2011-12-31	$250,000
Total contributions received or receivable from participants	2011-12-31	$36,178
Other income received	2011-12-31	$-25,083
Net income (gross income less expenses)	2011-12-31	$27,626
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$787,314
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$759,688
Total contributions received or receivable from employer(s)	2011-12-31	$22,907
2010 : LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$110,295
Expenses. Total of all expenses incurred	2010-12-31	$10,918
Benefits paid (including direct rollovers)	2010-12-31	$10,652
Total plan assets at end of year	2010-12-31	$759,688
Total plan assets at beginning of year	2010-12-31	$660,311
Value of fidelity bond covering the plan	2010-12-31	$250,000
Total contributions received or receivable from participants	2010-12-31	$41,651
Contributions received from other sources (not participants or employers)	2010-12-31	$8,801
Other income received	2010-12-31	$39,217
Net income (gross income less expenses)	2010-12-31	$99,377
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$759,688
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$660,311
Total contributions received or receivable from employer(s)	2010-12-31	$20,626
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	$266
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : LUSK & COMPANY PROFIT SHARING 401(K) 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 LUSK & COMPANY PROFIT SHARING 401(K) PLAN

2017: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	This submission is the final filing	Yes
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: LUSK & COMPANY PROFIT SHARING 401(K) PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331959-01

Policy instance

Insurance contract or identification number	331959-01
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	JAMES IZETT

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331959-01

Policy instance

Insurance contract or identification number	331959-01
Number of Individuals Covered	20
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,703
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,660
Insurance broker organization code?	3
Insurance broker name	JAMES IZETT

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331959-01

Policy instance

Insurance contract or identification number	331959-01
Number of Individuals Covered	19
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,295
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,295
Insurance broker organization code?	3
Insurance broker name	JAMES IZETT

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331959-01

Policy instance

Insurance contract or identification number	331959-01
Number of Individuals Covered	19
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,981
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $947
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES IZETT

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331959-01

Policy instance

Insurance contract or identification number	331959-01
Number of Individuals Covered	21
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,456
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AXA EQUITABLE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66944 )

Policy contract number

600359

Policy instance

Insurance contract or identification number	600359
Number of Individuals Covered	9
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $738
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $738
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES IZETT, CHFC, CLU

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )

Policy contract number

331959-01

Policy instance

Insurance contract or identification number	331959-01
Number of Individuals Covered	21
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $6,831
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,148
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	DAVID WESTNEDGE

Potentially related plans

LUSK & LUSK [EIN = 630375119]

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Company Name:	LUSK & COMPANY, INC.
Employer identification number (EIN):	208450771
NAIC Classification:	314000
NAIC Description:	Textile Product Mills