401k Plan data: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN plan

SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 401k Plan overview

Plan Name	SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN
Plan identification number	510

SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

SNAVELY FOREST PRODUCTS, INC. has sponsored the creation of one or more 401k plans.

Company Name: SNAVELY FOREST PRODUCTS, INC.

Employer identification number (EIN): 250982296

NAIC Classification: 113110
NAIC Description: Timber Tract Operations

Additional information about SNAVELY FOREST PRODUCTS, INC.

Jurisdiction of Incorporation: Texas Secretary of State

Incorporation Date: 2018-01-18

Company Identification Number: 0802911169

Legal Registered Office Address: 2400 WYCLIFF ST

SAINT PAUL
United States of America (USA)
55114

More information about SNAVELY FOREST PRODUCTS, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
510 2018-01-01 JOHN STOCKHAUSEN JOHN STOCKHAUSEN 2019-03-07
510 2017-01-01 JOHN STOCKHAUSEN JOHN STOCKHAUSEN 2018-08-28
510 2016-01-01 JOHN STOCKHAUSEN JOHN STOCKHAUSEN 2017-09-27
510 2015-01-01 JOHN STOCKHAUSEN JOHN STOCKHAUSEN 2016-08-09
510 2014-01-01 JOHN STOCKHAUSEN JOHN STOCKHAUSEN 2015-07-14
510 2013-01-01 JOHN STOCKHAUSEN JOHN STOCKHAUSEN 2014-09-17
510 2012-01-01 JOHN STOCKHAUSEN JOHN STOCKHAUSEN 2013-05-13
510 2011-01-01 JOHN STOCKHAUSEN JOHN STOCKHAUSEN 2012-08-07
510 2010-01-01 DONALD STEINHART DONALD STEINHART 2011-07-18
510 2009-01-01 DONALD STEINHART DONALD STEINHART 2010-06-28

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
510	2018-01-01	JOHN STOCKHAUSEN	JOHN STOCKHAUSEN	2019-03-07
510	2017-01-01	JOHN STOCKHAUSEN	JOHN STOCKHAUSEN	2018-08-28
510	2016-01-01	JOHN STOCKHAUSEN	JOHN STOCKHAUSEN	2017-09-27
510	2015-01-01	JOHN STOCKHAUSEN	JOHN STOCKHAUSEN	2016-08-09
510	2014-01-01	JOHN STOCKHAUSEN	JOHN STOCKHAUSEN	2015-07-14
510	2013-01-01	JOHN STOCKHAUSEN	JOHN STOCKHAUSEN	2014-09-17
510	2012-01-01	JOHN STOCKHAUSEN	JOHN STOCKHAUSEN	2013-05-13
510	2011-01-01	JOHN STOCKHAUSEN	JOHN STOCKHAUSEN	2012-08-07
510	2010-01-01	DONALD STEINHART	DONALD STEINHART	2011-07-18
510	2009-01-01	DONALD STEINHART	DONALD STEINHART	2010-06-28

Plan Statistics for SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN

401k plan membership statisitcs for SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN

Measure Date Value
2018: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 150
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0
2017: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 134
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 147
Number of retired or separated participants receiving benefits 2017-01-01 3
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 150
2016: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 145
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 133
Number of retired or separated participants receiving benefits 2016-01-01 1
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 134
2015: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 144
Number of retired or separated participants receiving benefits 2015-01-01 1
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 145
2014: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 157
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 150
Number of retired or separated participants receiving benefits 2014-01-01 2
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 152
2013: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 142
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 154
Number of retired or separated participants receiving benefits 2013-01-01 3
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 157
2012: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 152
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 139
Number of retired or separated participants receiving benefits 2012-01-01 3
Number of other retired or separated participants entitled to future benefits 2012-01-01 0
Total of all active and inactive participants 2012-01-01 142
2011: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 165
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 147
Number of retired or separated participants receiving benefits 2011-01-01 5
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 152
2010: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 184
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 158
Number of retired or separated participants receiving benefits 2010-01-01 7
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 165
2009: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 229
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 181
Number of retired or separated participants receiving benefits 2009-01-01 3
Number of other retired or separated participants entitled to future benefits 2009-01-01 0
Total of all active and inactive participants 2009-01-01 184

Measure	Date	Value
2018: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	150
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
2017: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	134
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	147
Number of retired or separated participants receiving benefits	2017-01-01	3
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	150
2016: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	145
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	133
Number of retired or separated participants receiving benefits	2016-01-01	1
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	134
2015: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	144
Number of retired or separated participants receiving benefits	2015-01-01	1
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	145
2014: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	157
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	150
Number of retired or separated participants receiving benefits	2014-01-01	2
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	152
2013: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	142
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	154
Number of retired or separated participants receiving benefits	2013-01-01	3
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	157
2012: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	152
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	139
Number of retired or separated participants receiving benefits	2012-01-01	3
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	142
2011: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	165
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	147
Number of retired or separated participants receiving benefits	2011-01-01	5
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	152
2010: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	184
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	158
Number of retired or separated participants receiving benefits	2010-01-01	7
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	165
2009: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	229
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	181
Number of retired or separated participants receiving benefits	2009-01-01	3
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	184

Form 5500 Responses for SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN

2018: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	This submission is the final filing	Yes
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: SNAVELY FOREST PRODUCTS GROUP HEALTH 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 funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: SNAVELY FOREST PRODUCTS GROUP HEALTH 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: SNAVELY FOREST PRODUCTS GROUP HEALTH 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: SNAVELY FOREST PRODUCTS GROUP HEALTH 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: SNAVELY FOREST PRODUCTS GROUP HEALTH 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: SNAVELY FOREST PRODUCTS GROUP HEALTH 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: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: SNAVELY FOREST PRODUCTS GROUP HEALTH PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD606400/SUBS

Policy instance

Insurance contract or identification number	SGD606400/SUBS
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $3,797
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $53,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,797
Insurance broker organization code?	3

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

64774428

Policy instance

Insurance contract or identification number	64774428
Number of Individuals Covered	0
Insurance policy start date	2017-04-12
Insurance policy end date	2018-02-01
Total amount of commissions paid to insurance broker	USD $300
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $300
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01016708

Policy instance

Insurance contract or identification number	01016708
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $38,572
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,142,083
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $38,572
Insurance broker organization code?	3

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

903617 AND SUBS

Policy instance

Insurance contract or identification number	903617 AND SUBS
Number of Individuals Covered	0
Insurance policy start date	2018-01-01
Insurance policy end date	2018-09-30
Total amount of commissions paid to insurance broker	USD $3,505
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,505
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01016708

Policy instance

Insurance contract or identification number	01016708
Number of Individuals Covered	296
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $44,783
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,418,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $44,783
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES NATIONAL,INC

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000064774428

Policy instance

Insurance contract or identification number	000064774428
Number of Individuals Covered	105
Insurance policy start date	2016-04-12
Insurance policy end date	2017-04-12
Total amount of commissions paid to insurance broker	USD $369
Total amount of fees paid to insurance company	USD $154
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $2,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $369
Amount paid for insurance broker fees	154
Additional information about fees paid to insurance broker	GUARANTEED SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HENDERSON BROTHERS, INC.

UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )

Policy contract number

903617

Policy instance

Insurance contract or identification number	903617
Number of Individuals Covered	273
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Total amount of commissions paid to insurance broker	USD $4,406
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,406
Insurance broker organization code?	3
Insurance broker name	USI INSURANCE SERVICES NATIONAL,INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGD606400/SUBS

Policy instance

Insurance contract or identification number	SGD606400/SUBS
Number of Individuals Covered	225
Insurance policy start date	2016-02-01
Insurance policy end date	2017-01-31
Total amount of commissions paid to insurance broker	USD $5,723
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $53,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,723
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INSURANCE SERVICES

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016035-00

Policy instance

Insurance contract or identification number	01-016035-00
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $582
Total amount of fees paid to insurance company	USD $499
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $4,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $582
Amount paid for insurance broker fees	499
Additional information about fees paid to insurance broker	GROUP MARKETING SUPPORT FEE
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES OF PA

UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )

Policy contract number

903617

Policy instance

Insurance contract or identification number	903617
Number of Individuals Covered	268
Insurance policy start date	2015-10-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $672
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $15,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $672
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )

Policy contract number

04819

Policy instance

Insurance contract or identification number	04819
Number of Individuals Covered	0
Insurance policy start date	2015-01-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $3,013
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,013
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES OF PA

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000064774428

Policy instance

Insurance contract or identification number	000064774428
Number of Individuals Covered	8
Insurance policy start date	2014-04-12
Insurance policy end date	2015-04-12
Total amount of commissions paid to insurance broker	USD $421
Total amount of fees paid to insurance company	USD $196
Other welfare benefits provided	EXECUTIVE TRAVEL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $421
Amount paid for insurance broker fees	196
Additional information about fees paid to insurance broker	GUARANTEED SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HENDERSON BROTHERS, INC.

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01016708

Policy instance

Insurance contract or identification number	01016708
Number of Individuals Covered	257
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Total amount of commissions paid to insurance broker	USD $34,846
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,169,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,846
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000064774428

Policy instance

Insurance contract or identification number	000064774428
Number of Individuals Covered	150
Insurance policy start date	2013-04-12
Insurance policy end date	2014-04-11
Total amount of commissions paid to insurance broker	USD $421
Total amount of fees paid to insurance company	USD $112
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	TRAVEL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $421
Amount paid for insurance broker fees	112
Additional information about fees paid to insurance broker	GUARANTEED SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HENDERSON BROTHERS, INC.

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01016708

Policy instance

Insurance contract or identification number	01016708
Number of Individuals Covered	112
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $35,817
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,337,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,817
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016035-00

Policy instance

Insurance contract or identification number	01-016035-00
Number of Individuals Covered	140
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $12,597
Total amount of fees paid to insurance company	USD $1,026
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $41,109
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,597
Insurance broker organization code?	3
Amount paid for insurance broker fees	1026
Additional information about fees paid to insurance broker	GROUP MARKETING SUPPORT FEE
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )

Policy contract number

04819

Policy instance

Insurance contract or identification number	04819
Number of Individuals Covered	113
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Total amount of commissions paid to insurance broker	USD $3,903
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $60,043
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,903
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01016708

Policy instance

Insurance contract or identification number	01016708
Number of Individuals Covered	115
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $35,579
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,165,557
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,579
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000064774428

Policy instance

Insurance contract or identification number	000064774428
Number of Individuals Covered	154
Insurance policy start date	2012-04-12
Insurance policy end date	2013-04-11
Total amount of commissions paid to insurance broker	USD $421
Total amount of fees paid to insurance company	USD $49
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	TRAVEL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $421
Amount paid for insurance broker fees	49
Additional information about fees paid to insurance broker	GUARANTEED SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HENDERSON BROTHERS, INC.

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016035-00

Policy instance

Insurance contract or identification number	01-016035-00
Number of Individuals Covered	146
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $802
Total amount of fees paid to insurance company	USD $816
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $32,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $802
Amount paid for insurance broker fees	816
Additional information about fees paid to insurance broker	GROUP MARKETING SUPPORT FEE
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )

Policy contract number

04819

Policy instance

Insurance contract or identification number	04819
Number of Individuals Covered	117
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $3,553
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $54,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,553
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000064774428

Policy instance

Insurance contract or identification number	000064774428
Number of Individuals Covered	139
Insurance policy start date	2011-04-12
Insurance policy end date	2012-04-11
Total amount of commissions paid to insurance broker	USD $421
Total amount of fees paid to insurance company	USD $157
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	TRAVEL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $421
Amount paid for insurance broker fees	157
Additional information about fees paid to insurance broker	GUARANTEED SUPPLEMENTAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HENDERSON BROTHERS, INC.

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

863653G

Policy instance

Insurance contract or identification number	863653G
Number of Individuals Covered	139
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $6,237
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $40,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,237
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

04640603

Policy instance

Insurance contract or identification number	04640603
Number of Individuals Covered	104
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $36,088
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,202,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,088
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000064774428

Policy instance

Insurance contract or identification number	000064774428
Number of Individuals Covered	147
Insurance policy start date	2010-04-12
Insurance policy end date	2011-04-11
Total amount of commissions paid to insurance broker	USD $421
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	TRAVEL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

04640603

Policy instance

Insurance contract or identification number	04640603
Number of Individuals Covered	129
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $38,713
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,291,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

863653G

Policy instance

Insurance contract or identification number	863653G
Number of Individuals Covered	145
Insurance policy start date	2010-11-01
Insurance policy end date	2011-10-31
Total amount of commissions paid to insurance broker	USD $1,561
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

863653G

Policy instance

Insurance contract or identification number	863653G
Number of Individuals Covered	158
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $4,726
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $38,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,726
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )

Policy contract number

000064774428

Policy instance

Insurance contract or identification number	000064774428
Number of Individuals Covered	150
Insurance policy start date	2009-04-12
Insurance policy end date	2010-04-11
Total amount of commissions paid to insurance broker	USD $421
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	TRAVEL AD&D
Welfare Benefit Premiums Paid to Carrier	USD $2,807
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $421
Insurance broker organization code?	3
Insurance broker name	HENDERSON BROTHERS, INC.

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01016700

Policy instance

Insurance contract or identification number	01016700
Number of Individuals Covered	139
Insurance policy start date	2009-11-01
Insurance policy end date	2010-10-31
Total amount of commissions paid to insurance broker	USD $37,787
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,350,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,787
Insurance broker organization code?	3
Insurance broker name	WELLS FARGO INS SERVICES USA, INC.

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Company Name:	SNAVELY FOREST PRODUCTS, INC.
Employer identification number (EIN):	250982296
NAIC Classification:	113110
NAIC Description:	Timber Tract Operations

Jurisdiction of Incorporation:	Texas Secretary of State
Incorporation Date:	2018-01-18
Company Identification Number:	0802911169
Legal Registered Office Address:	2400 WYCLIFF ST SAINT PAUL United States of America (USA) 55114