401k Plan data: INKCYCLE, INC. EMPLOYEE WELFARE PLAN plan

INKCYCLE, INC. EMPLOYEE WELFARE PLAN 401k Plan overview

Plan Name	INKCYCLE, INC. EMPLOYEE WELFARE PLAN
Plan identification number	501

INKCYCLE, INC. EMPLOYEE WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Temporary disability (accident and sickness) Long-term disability cover Other welfare benefit cover Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

INKCYCLE, INC. has sponsored the creation of one or more 401k plans.

Company Name: INKCYCLE, INC.

Employer identification number (EIN): 481146277

NAIC Classification: 339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INKCYCLE, INC. EMPLOYEE WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-03-01 PAULA BYRNES
501 2015-03-01 PAULA BYRNES
501 2014-03-01 PAULA BYRNES
501 2013-03-01 PAULA BYRNES
501 2012-03-01 PAULA BYRNES
501 2011-03-01 PAULA BYRNES
501 2009-03-01 PAULA BYRNES
501 2009-03-01 PAULA BYRNES
501 2009-03-01 PAULA BYRNES

Plan id#	Filing Submission Date	Name of Administrator
501	2015-03-01	PAULA BYRNES
501	2015-03-01	PAULA BYRNES
501	2014-03-01	PAULA BYRNES
501	2013-03-01	PAULA BYRNES
501	2012-03-01	PAULA BYRNES
501	2011-03-01	PAULA BYRNES
501	2009-03-01	PAULA BYRNES
501	2009-03-01	PAULA BYRNES
501	2009-03-01	PAULA BYRNES

Plan Statistics for INKCYCLE, INC. EMPLOYEE WELFARE PLAN

401k plan membership statisitcs for INKCYCLE, INC. EMPLOYEE WELFARE PLAN

Measure Date Value
2015: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-03-01 109
Total number of active participants reported on line 7a of the Form 5500 2015-03-01 84
Number of retired or separated participants receiving benefits 2015-03-01 0
Number of other retired or separated participants entitled to future benefits 2015-03-01 0
Total of all active and inactive participants 2015-03-01 84
2014: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-03-01 154
Total number of active participants reported on line 7a of the Form 5500 2014-03-01 109
Number of retired or separated participants receiving benefits 2014-03-01 0
Number of other retired or separated participants entitled to future benefits 2014-03-01 0
Total of all active and inactive participants 2014-03-01 109
2013: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-03-01 169
Total number of active participants reported on line 7a of the Form 5500 2013-03-01 154
Total of all active and inactive participants 2013-03-01 154
2012: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-03-01 192
Total number of active participants reported on line 7a of the Form 5500 2012-03-01 169
Total of all active and inactive participants 2012-03-01 169
2011: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-03-01 207
Total number of active participants reported on line 7a of the Form 5500 2011-03-01 192
Total of all active and inactive participants 2011-03-01 192
2009: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-03-01 209
Total number of active participants reported on line 7a of the Form 5500 2009-03-01 238
Total of all active and inactive participants 2009-03-01 238

Measure	Date	Value
2015: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-03-01	109
Total number of active participants reported on line 7a of the Form 5500	2015-03-01	84
Number of retired or separated participants receiving benefits	2015-03-01	0
Number of other retired or separated participants entitled to future benefits	2015-03-01	0
Total of all active and inactive participants	2015-03-01	84
2014: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-03-01	154
Total number of active participants reported on line 7a of the Form 5500	2014-03-01	109
Number of retired or separated participants receiving benefits	2014-03-01	0
Number of other retired or separated participants entitled to future benefits	2014-03-01	0
Total of all active and inactive participants	2014-03-01	109
2013: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-03-01	169
Total number of active participants reported on line 7a of the Form 5500	2013-03-01	154
Total of all active and inactive participants	2013-03-01	154
2012: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-03-01	192
Total number of active participants reported on line 7a of the Form 5500	2012-03-01	169
Total of all active and inactive participants	2012-03-01	169
2011: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-03-01	207
Total number of active participants reported on line 7a of the Form 5500	2011-03-01	192
Total of all active and inactive participants	2011-03-01	192
2009: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-03-01	209
Total number of active participants reported on line 7a of the Form 5500	2009-03-01	238
Total of all active and inactive participants	2009-03-01	238

Form 5500 Responses for INKCYCLE, INC. EMPLOYEE WELFARE PLAN

2015: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2015 form 5500 responses
2015-03-01	Type of plan entity	Single employer plan
2015-03-01	Submission has been amended	Yes
2015-03-01	Plan funding arrangement – Insurance	Yes
2015-03-01	Plan benefit arrangement – Insurance	Yes
2014: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2014 form 5500 responses
2014-03-01	Type of plan entity	Single employer plan
2014-03-01	Plan funding arrangement – Insurance	Yes
2014-03-01	Plan benefit arrangement – Insurance	Yes
2013: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2013 form 5500 responses
2013-03-01	Type of plan entity	Single employer plan
2013-03-01	Plan funding arrangement – Insurance	Yes
2013-03-01	Plan benefit arrangement – Insurance	Yes
2012: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2012 form 5500 responses
2012-03-01	Type of plan entity	Single employer plan
2012-03-01	Plan funding arrangement – Insurance	Yes
2012-03-01	Plan benefit arrangement – Insurance	Yes
2011: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2011 form 5500 responses
2011-03-01	Type of plan entity	Single employer plan
2011-03-01	Plan funding arrangement – Insurance	Yes
2011-03-01	Plan benefit arrangement – Insurance	Yes
2009: INKCYCLE, INC. EMPLOYEE WELFARE PLAN 2009 form 5500 responses
2009-03-01	Type of plan entity	Single employer plan
2009-03-01	Submission has been amended	Yes
2009-03-01	Plan funding arrangement – Insurance	Yes
2009-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AIMK

Policy instance

Insurance contract or identification number	GLUG0AIMK
Number of Individuals Covered	84
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $909
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $6,060
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

22525000

Policy instance

Insurance contract or identification number	22525000
Number of Individuals Covered	153
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $15,401
Total amount of fees paid to insurance company	USD $12,062
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $594,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUPR0AIMK

Policy instance

Insurance contract or identification number	GUPR0AIMK
Number of Individuals Covered	50
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $3,213
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $21,423
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00338678

Policy instance

Insurance contract or identification number	00338678
Number of Individuals Covered	74
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $2,832
Total amount of fees paid to insurance company	USD $4,798
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $55,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0AIMK

Policy instance

Insurance contract or identification number	GUC0AIMK
Number of Individuals Covered	53
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $3,469
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $23,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AIMK

Policy instance

Insurance contract or identification number	GVTL0AIMK
Number of Individuals Covered	35
Insurance policy start date	2015-03-01
Insurance policy end date	2016-02-29
Total amount of commissions paid to insurance broker	USD $1,329
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $13,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0AIMK

Policy instance

Insurance contract or identification number	GUC0AIMK
Number of Individuals Covered	68
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $4,597
Total amount of fees paid to insurance company	USD $1,644
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,647
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,597
Amount paid for insurance broker fees	1644
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00338678

Policy instance

Insurance contract or identification number	00338678
Number of Individuals Covered	105
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $3,178
Total amount of fees paid to insurance company	USD $4,955
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,178
Amount paid for insurance broker fees	4955
Additional information about fees paid to insurance broker	ADMINISTRATION SERVICES
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUPR0AIMK

Policy instance

Insurance contract or identification number	GUPR0AIMK
Number of Individuals Covered	67
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $4,025
Total amount of fees paid to insurance company	USD $1,430
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $26,834
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,025
Amount paid for insurance broker fees	1430
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

22525000

Policy instance

Insurance contract or identification number	22525000
Number of Individuals Covered	195
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $20,427
Total amount of fees paid to insurance company	USD $12,118
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $788,700
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,427
Amount paid for insurance broker fees	12118
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AIMK

Policy instance

Insurance contract or identification number	GLUG0AIMK
Number of Individuals Covered	123
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $1,273
Total amount of fees paid to insurance company	USD $438
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $8,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,273
Amount paid for insurance broker fees	438
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AIMK

Policy instance

Insurance contract or identification number	GVTL0AIMK
Number of Individuals Covered	55
Insurance policy start date	2014-03-01
Insurance policy end date	2015-02-28
Total amount of commissions paid to insurance broker	USD $1,606
Total amount of fees paid to insurance company	USD $904
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $16,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,606
Amount paid for insurance broker fees	904
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AIMK

Policy instance

Insurance contract or identification number	GVTL0AIMK
Number of Individuals Covered	65
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $1,952
Total amount of fees paid to insurance company	USD $1,450
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $19,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,952
Amount paid for insurance broker fees	1450
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0AIMK

Policy instance

Insurance contract or identification number	GUC0AIMK
Number of Individuals Covered	92
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $5,421
Total amount of fees paid to insurance company	USD $2,640
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,421
Amount paid for insurance broker fees	2640
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUPR0AIMK

Policy instance

Insurance contract or identification number	GUPR0AIMK
Number of Individuals Covered	84
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $4,724
Total amount of fees paid to insurance company	USD $2,243
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,724
Amount paid for insurance broker fees	2243
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

22525000

Policy instance

Insurance contract or identification number	22525000
Number of Individuals Covered	224
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $22,819
Total amount of fees paid to insurance company	USD $17,213
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $845,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,819
Amount paid for insurance broker fees	17213
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AIMK

Policy instance

Insurance contract or identification number	GLUG0AIMK
Number of Individuals Covered	154
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $1,438
Total amount of fees paid to insurance company	USD $786
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $9,587
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,438
Amount paid for insurance broker fees	786
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00338678

Policy instance

Insurance contract or identification number	00338678
Number of Individuals Covered	135
Insurance policy start date	2013-03-01
Insurance policy end date	2014-02-28
Total amount of commissions paid to insurance broker	USD $3,128
Total amount of fees paid to insurance company	USD $6,310
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $74,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,116
Amount paid for insurance broker fees	6310
Additional information about fees paid to insurance broker	ADMINISTRATION SERVICES
Insurance broker organization code?	3
Insurance broker name	WOODY FINANCIAL GROUP INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AIMK

Policy instance

Insurance contract or identification number	GLUG0AIMK
Number of Individuals Covered	169
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $1,788
Total amount of fees paid to insurance company	USD $372
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $11,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,788
Amount paid for insurance broker fees	372
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

22525000

Policy instance

Insurance contract or identification number	22525000
Number of Individuals Covered	271
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $26,948
Total amount of fees paid to insurance company	USD $20,273
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $998,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,948
Amount paid for insurance broker fees	20273
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUPR0AIMK

Policy instance

Insurance contract or identification number	GUPR0AIMK
Number of Individuals Covered	94
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $5,210
Total amount of fees paid to insurance company	USD $1,058
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,210
Amount paid for insurance broker fees	1058
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00338678

Policy instance

Insurance contract or identification number	00338678
Number of Individuals Covered	162
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,548
Total amount of fees paid to insurance company	USD $26,855
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $101,987
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,530
Amount paid for insurance broker fees	26855
Additional information about fees paid to insurance broker	ADMINISTRATION SERVICES
Insurance broker organization code?	3
Insurance broker name	WOODY FINANCIAL GROUP INC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0AIMK

Policy instance

Insurance contract or identification number	GUC0AIMK
Number of Individuals Covered	99
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $6,021
Total amount of fees paid to insurance company	USD $1,365
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,021
Amount paid for insurance broker fees	1365
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AIMK

Policy instance

Insurance contract or identification number	GVTL0AIMK
Number of Individuals Covered	80
Insurance policy start date	2012-03-01
Insurance policy end date	2013-02-28
Total amount of commissions paid to insurance broker	USD $2,215
Total amount of fees paid to insurance company	USD $706
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $22,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,215
Amount paid for insurance broker fees	706
Additional information about fees paid to insurance broker	OTHER COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUC0AIMK

Policy instance

Insurance contract or identification number	GUC0AIMK
Number of Individuals Covered	107
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $6,228
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,520
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00338678

Policy instance

Insurance contract or identification number	00338678
Number of Individuals Covered	168
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $3,621
Total amount of fees paid to insurance company	USD $5,358
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $106,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GUPR0AIMK

Policy instance

Insurance contract or identification number	GUPR0AIMK
Number of Individuals Covered	104
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $4,918
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

22525000

Policy instance

Insurance contract or identification number	22525000
Number of Individuals Covered	333
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $28,185
Total amount of fees paid to insurance company	USD $20,692
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,043,904
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GLUG0AIMK

Policy instance

Insurance contract or identification number	GLUG0AIMK
Number of Individuals Covered	192
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $1,777
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $11,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

GVTL0AIMK

Policy instance

Insurance contract or identification number	GVTL0AIMK
Number of Individuals Covered	93
Insurance policy start date	2011-03-01
Insurance policy end date	2012-02-29
Total amount of commissions paid to insurance broker	USD $2,219
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY ADD
Welfare Benefit Premiums Paid to Carrier	USD $22,187
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00338678

Policy instance

Insurance contract or identification number	00338678
Number of Individuals Covered	214
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $3,770
Total amount of fees paid to insurance company	USD $5,987
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $116,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,751
Amount paid for insurance broker fees	5987
Additional information about fees paid to insurance broker	ADMINISTRATION SERVICES
Insurance broker organization code?	3
Insurance broker name	WOODY FINANCIAL GROUP INC

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

22525000

Policy instance

Insurance contract or identification number	22525000
Number of Individuals Covered	381
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $32,666
Total amount of fees paid to insurance company	USD $24,562
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,207,964
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,666
Amount paid for insurance broker fees	24562
Additional information about fees paid to insurance broker	ADMIN SERVICESNONMONETARY COMP
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

KM05738003

Policy instance

Insurance contract or identification number	KM05738003
Number of Individuals Covered	258
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $3,613
Total amount of fees paid to insurance company	USD $589
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $31,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,613
Amount paid for insurance broker fees	589
Additional information about fees paid to insurance broker	SUPPLEMENTALNONMONETARY COMP
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 )

Policy contract number

G00451716

Policy instance

Insurance contract or identification number	G00451716
Number of Individuals Covered	120
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $7,426
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $86,375
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,426
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

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Company Name:	INKCYCLE, INC.
Employer identification number (EIN):	481146277
NAIC Classification:	339900