401k Plan data: UNIVERSAL ATHLETIC CLUB 401(K) PLAN plan

UNIVERSAL ATHLETIC CLUB 401(K) PLAN 401k Plan overview

Plan Name	UNIVERSAL ATHLETIC CLUB 401(K) PLAN
Plan identification number	001

UNIVERSAL ATHLETIC CLUB 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.
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

UNIVERSAL ATHLETIC CLUB has sponsored the creation of one or more 401k plans.

Company Name: UNIVERSAL ATHLETIC CLUB

Employer identification number (EIN): 232774183

NAIC Classification: 713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNIVERSAL ATHLETIC CLUB 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2019-01-01 MARY CASSELBURY 2020-02-04
001 2018-01-01 MARY CASSELBURY 2019-08-19
001 2017-01-01 MARY CASSELBURY 2018-08-16
001 2016-01-01 DANIEL M. GONZALES 2017-10-16
001 2015-01-01 DANIEL GONZALEZ 2016-08-24
001 2014-01-01 DANIEL GONZALEZ 2015-09-29
001 2013-01-01 DANIEL GONZALEZ 2014-12-30
001 2012-01-01 DANIEL GONZALEZ DANIEL GONZALEZ 2013-10-15
001 2011-01-01 DANIEL M. GONZALEZ
001 2009-01-01 MARY CASSELBURY

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2019-01-01	MARY CASSELBURY	2020-02-04
001	2018-01-01	MARY CASSELBURY	2019-08-19
001	2017-01-01	MARY CASSELBURY	2018-08-16
001	2016-01-01	DANIEL M. GONZALES	2017-10-16
001	2015-01-01	DANIEL GONZALEZ	2016-08-24
001	2014-01-01	DANIEL GONZALEZ	2015-09-29
001	2013-01-01	DANIEL GONZALEZ	2014-12-30
001	2012-01-01	DANIEL GONZALEZ		DANIEL GONZALEZ	2013-10-15
001	2011-01-01	DANIEL M. GONZALEZ
001	2009-01-01	MARY CASSELBURY

Plan Statistics for UNIVERSAL ATHLETIC CLUB 401(K) PLAN

401k plan membership statisitcs for UNIVERSAL ATHLETIC CLUB 401(K) PLAN

Measure Date Value
2012: UNIVERSAL ATHLETIC CLUB 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 117
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 84
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 15
Total of all active and inactive participants 2012-01-01 99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 99
Number of participants with account balances 2012-01-01 39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: UNIVERSAL ATHLETIC CLUB 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 120
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 8
Total of all active and inactive participants 2011-01-01 128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 128
Number of participants with account balances 2011-01-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2009: UNIVERSAL ATHLETIC CLUB 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 155
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 135
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 10
Total of all active and inactive participants 2009-01-01 145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 145
Number of participants with account balances 2009-01-01 51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2012: UNIVERSAL ATHLETIC CLUB 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	117
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	84
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	15
Total of all active and inactive participants	2012-01-01	99
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	99
Number of participants with account balances	2012-01-01	39
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: UNIVERSAL ATHLETIC CLUB 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	120
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	8
Total of all active and inactive participants	2011-01-01	128
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	128
Number of participants with account balances	2011-01-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2009: UNIVERSAL ATHLETIC CLUB 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	155
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	135
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	10
Total of all active and inactive participants	2009-01-01	145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	145
Number of participants with account balances	2009-01-01	51
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on UNIVERSAL ATHLETIC CLUB 401(K) PLAN

Measure	Date	Value
2012 : UNIVERSAL ATHLETIC CLUB 401(K) PLAN 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	$163,271
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$38,225
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$27,315
Value of total corrective distributions	2012-12-31	$1,429
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$55,899
Value of total assets at end of year	2012-12-31	$1,058,548
Value of total assets at beginning of year	2012-12-31	$933,502
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$9,481
Total interest from all sources	2012-12-31	$446
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	No
Administrative expenses professional fees incurred	2012-12-31	$1,688
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$20,000
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	$55,944
Participant contributions at end of year	2012-12-31	$19,423
Participant contributions at beginning of year	2012-12-31	$27,396
Participant contributions at end of year	2012-12-31	$4,126
Participant contributions at beginning of year	2012-12-31	$2,575
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$-45
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$45
Other income not declared elsewhere	2012-12-31	$2,468
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	$125,046
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,058,548
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$933,502
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
Investment advisory and management fees	2012-12-31	$7,793
Value of interest in pooled separate accounts at end of year	2012-12-31	$888,479
Value of interest in pooled separate accounts at beginning of year	2012-12-31	$764,353
Interest on participant loans	2012-12-31	$446
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$146,520
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$139,133
Net investment gain/loss from pooled separate accounts	2012-12-31	$104,458
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$27,315
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	TROUT, EBERSOLE AND GROFF LLP
Accountancy firm EIN	2012-12-31	231551315
2011 : UNIVERSAL ATHLETIC CLUB 401(K) PLAN 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	$26,399
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$63,158
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$45,536
Expenses. Certain deemed distributions of participant loans	2011-12-31	$757
Value of total corrective distributions	2011-12-31	$7,508
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$71,404
Value of total assets at end of year	2011-12-31	$933,502
Value of total assets at beginning of year	2011-12-31	$970,261
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$9,357
Total interest from all sources	2011-12-31	$1,314
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
Administrative expenses professional fees incurred	2011-12-31	$2,195
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$75,000
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	$71,404
Participant contributions at end of year	2011-12-31	$27,396
Participant contributions at beginning of year	2011-12-31	$35,304
Participant contributions at end of year	2011-12-31	$2,575
Participant contributions at beginning of year	2011-12-31	$2,590
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$45
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$58
Other income not declared elsewhere	2011-12-31	$1,622
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	$-36,759
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$933,502
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$970,261
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
Investment advisory and management fees	2011-12-31	$7,162
Value of interest in pooled separate accounts at end of year	2011-12-31	$764,353
Value of interest in pooled separate accounts at beginning of year	2011-12-31	$906,433
Interest on participant loans	2011-12-31	$1,314
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$139,133
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$25,876
Net investment gain/loss from pooled separate accounts	2011-12-31	$-47,941
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$45,536
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	TROUT, EBERSOLE AND GROFF LLP
Accountancy firm EIN	2011-12-31	231551315
2010 : UNIVERSAL ATHLETIC CLUB 401(K) PLAN 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	$199,470
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$27,205
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$6,385
Value of total corrective distributions	2010-12-31	$12,156
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$78,930
Value of total assets at end of year	2010-12-31	$970,261
Value of total assets at beginning of year	2010-12-31	$797,996
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$8,664
Total interest from all sources	2010-12-31	$1,575
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
Administrative expenses professional fees incurred	2010-12-31	$1,602
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$75,000
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	$78,930
Participant contributions at end of year	2010-12-31	$35,304
Participant contributions at beginning of year	2010-12-31	$36,089
Participant contributions at end of year	2010-12-31	$2,648
Other income not declared elsewhere	2010-12-31	$1,071
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	$172,265
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$970,261
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$797,996
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
Investment advisory and management fees	2010-12-31	$7,062
Value of interest in pooled separate accounts at end of year	2010-12-31	$906,433
Value of interest in pooled separate accounts at beginning of year	2010-12-31	$722,743
Interest on participant loans	2010-12-31	$1,575
Value of interest in common/collective trusts at beginning of year	2010-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$25,876
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$39,164
Net investment gain/loss from pooled separate accounts	2010-12-31	$117,894
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	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$6,385
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	TROUT, EBERSOLE AND GROFF LLP
Accountancy firm EIN	2010-12-31	231551315
2009 : UNIVERSAL ATHLETIC CLUB 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 UNIVERSAL ATHLETIC CLUB 401(K) PLAN

2012: UNIVERSAL ATHLETIC CLUB 401(K) 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 – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: UNIVERSAL ATHLETIC CLUB 401(K) 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 – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: UNIVERSAL ATHLETIC CLUB 401(K) 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 – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

996503-000

Policy instance

Insurance contract or identification number	996503-000
Number of Individuals Covered	39
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,436
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,598
Insurance broker organization code?	3
Insurance broker name	DAVID OVER

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

996503-000

Policy instance

Insurance contract or identification number	996503-000
Number of Individuals Covered	42
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,375
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

996503-000

Policy instance

Insurance contract or identification number	996503-000
Number of Individuals Covered	50
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,022
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 $2,022
Insurance broker organization code?	3
Insurance broker name	MARK A STONE

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Company Name:	UNIVERSAL ATHLETIC CLUB
Employer identification number (EIN):	232774183
NAIC Classification:	713900