UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 401k Plan overview

Plan Name	UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN
Plan identification number	001

UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1. Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met. Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash. Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities. 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

UNDERWRITERS SAFETY & CLAIMS, LLC has sponsored the creation of one or more 401k plans.

Company Name:	UNDERWRITERS SAFETY & CLAIMS, LLC
Employer identification number (EIN):	610489172
NAIC Classification:	524210
NAIC Description:	Insurance Agencies and Brokerages

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01
001	2021-01-01
001	2020-01-01
001	2020-01-01
001	2019-01-01
001	2018-01-01
001	2018-01-01
001	2017-01-01	JAMES K. JOHNSON		SCOTT C. FERGUSON	2018-08-27
001	2016-01-01	JAMES K. JOHNSON		SCOTT C. FERGUSON	2017-08-08
001	2015-01-01	JAMES K. JOHNSON		SCOTT C. FERGUSON	2016-08-08
001	2014-01-01	JAMES JOHNSON		SCOTT FERGUSON	2015-09-03
001	2013-01-01	JAMES JOHNSON		SCOTT FERGUSON	2014-09-24
001	2012-01-01	JAMES JOHNSON		SCOTT FERGUSON	2013-09-25
001	2011-01-01	JAMES JOHNSON		SCOTT FERGUSON	2012-09-19
001	2010-01-01	JAMES K. JOHNSON		SCOTT C. FERGUSON	2011-10-06
001	2009-01-01	JAMES K. JOHNSON		SCOTT C. FERGUSON	2010-10-12

Plan Statistics for UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN

401k plan membership statisitcs for UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN

Measure	Date	Value
2022: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	279
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	0
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	0
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	0
Number of participants with account balances	2022-01-01	0
2021: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	269
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	230
Number of retired or separated participants receiving benefits	2021-01-01	4
Number of other retired or separated participants entitled to future benefits	2021-01-01	45
Total of all active and inactive participants	2021-01-01	279
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	279
Number of participants with account balances	2021-01-01	269
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	15
2020: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	274
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	231
Number of retired or separated participants receiving benefits	2020-01-01	2
Number of other retired or separated participants entitled to future benefits	2020-01-01	36
Total of all active and inactive participants	2020-01-01	269
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	269
Number of participants with account balances	2020-01-01	261
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	16
2019: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	280
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	240
Number of retired or separated participants receiving benefits	2019-01-01	4
Number of other retired or separated participants entitled to future benefits	2019-01-01	30
Total of all active and inactive participants	2019-01-01	274
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	274
Number of participants with account balances	2019-01-01	268
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	13
2018: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	295
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	244
Number of retired or separated participants receiving benefits	2018-01-01	3
Number of other retired or separated participants entitled to future benefits	2018-01-01	33
Total of all active and inactive participants	2018-01-01	280
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-01-01	0
Total participants	2018-01-01	280
Number of participants with account balances	2018-01-01	270
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-01-01	2
2017: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	275
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	248
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	44
Total of all active and inactive participants	2017-01-01	295
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-01-01	0
Total participants	2017-01-01	295
Number of participants with account balances	2017-01-01	253
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-01-01	9
2016: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	327
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	258
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	16
Total of all active and inactive participants	2016-01-01	275
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	275
Number of participants with account balances	2016-01-01	281
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	13
2015: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	320
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	272
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	54
Total of all active and inactive participants	2015-01-01	327
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	327
Number of participants with account balances	2015-01-01	274
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	14
2014: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	296
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	279
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	37
Total of all active and inactive participants	2014-01-01	316
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	316
Number of participants with account balances	2014-01-01	249
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	7
2013: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	344
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	269
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	26
Total of all active and inactive participants	2013-01-01	295
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	1
Total participants	2013-01-01	296
Number of participants with account balances	2013-01-01	222
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	299
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	302
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	39
Total of all active and inactive participants	2012-01-01	341
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	1
Total participants	2012-01-01	342
Number of participants with account balances	2012-01-01	219
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	3
2011: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	295
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	257
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	39
Total of all active and inactive participants	2011-01-01	296
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	1
Total participants	2011-01-01	297
Number of participants with account balances	2011-01-01	223
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	300
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	255
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	39
Total of all active and inactive participants	2010-01-01	294
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	1
Total participants	2010-01-01	295
Number of participants with account balances	2010-01-01	223
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	2
2009: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	311
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	257
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	42
Total of all active and inactive participants	2009-01-01	299
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	1
Total participants	2009-01-01	300
Number of participants with account balances	2009-01-01	232
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	3

Financial Data on UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN

Measure	Date	Value
2022 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets	2022-06-21	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2022-06-21	$0
Total unrealized appreciation/depreciation of assets	2022-06-21	$0
Total transfer of assets to this plan	2022-06-21	$0
Total transfer of assets from this plan	2022-06-21	$21,969,018
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-06-21	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-06-21	$0
Expenses. Interest paid	2022-06-21	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2022-06-21	$0
Total income from all sources (including contributions)	2022-06-21	$-4,606,275
Total loss/gain on sale of assets	2022-06-21	$0
Total of all expenses incurred	2022-06-21	$19,676,607
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-06-21	$19,651,936
Expenses. Certain deemed distributions of participant loans	2022-06-21	$0
Value of total corrective distributions	2022-06-21	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-06-21	$0
Value of total assets at end of year	2022-06-21	$0
Value of total assets at beginning of year	2022-06-21	$46,251,900
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-06-21	$24,671
Total income from rents	2022-06-21	$0
Total interest from all sources	2022-06-21	$696
Total dividends received (eg from common stock, registered investment company shares)	2022-06-21	$35,495
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-06-21	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2022-06-21	$0
Total dividends received from registered investment company shares (eg mutual funds)	2022-06-21	$35,495
Assets. Real estate other than employer real property at end of year	2022-06-21	$0
Assets. Real estate other than employer real property at beginning of year	2022-06-21	$0
Administrative expenses professional fees incurred	2022-06-21	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2022-06-21	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2022-06-21	$0
Was this plan covered by a fidelity bond	2022-06-21	Yes
Value of fidelity bond cover	2022-06-21	$500,000
If this is an individual account plan, was there a blackout period	2022-06-21	No
Were there any nonexempt tranactions with any party-in-interest	2022-06-21	No
Contributions received from participants	2022-06-21	$0
Participant contributions at end of year	2022-06-21	$0
Participant contributions at beginning of year	2022-06-21	$73,500
Participant contributions at end of year	2022-06-21	$0
Participant contributions at beginning of year	2022-06-21	$0
Assets. Other investments not covered elsewhere at end of year	2022-06-21	$0
Assets. Other investments not covered elsewhere at beginning of year	2022-06-21	$0
Income. Received or receivable in cash from other sources (including rollovers)	2022-06-21	$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2022-06-21	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-06-21	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-06-21	$0
Assets. Loans (other than to participants) at end of year	2022-06-21	$0
Assets. Loans (other than to participants) at beginning of year	2022-06-21	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-06-21	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-06-21	$0
Other income not declared elsewhere	2022-06-21	$0
Administrative expenses (other) incurred	2022-06-21	$23,316
Liabilities. Value of operating payables at end of year	2022-06-21	$0
Liabilities. Value of operating payables at beginning of year	2022-06-21	$0
Total non interest bearing cash at end of year	2022-06-21	$0
Total non interest bearing cash at beginning of year	2022-06-21	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-06-21	No
Income. Non cash contributions	2022-06-21	$0
Value of net income/loss	2022-06-21	$-24,282,882
Value of net assets at end of year (total assets less liabilities)	2022-06-21	$0
Value of net assets at beginning of year (total assets less liabilities)	2022-06-21	$46,251,900
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-06-21	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-06-21	No
Were any leases to which the plan was party in default or uncollectible	2022-06-21	No
Assets. partnership/joint venture interests at end of year	2022-06-21	$0
Assets. partnership/joint venture interests at beginning of year	2022-06-21	$0
Investment advisory and management fees	2022-06-21	$1,355
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-06-21	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-06-21	$44,398,622
Value of interest in pooled separate accounts at end of year	2022-06-21	$0
Value of interest in pooled separate accounts at beginning of year	2022-06-21	$0
Interest on participant loans	2022-06-21	$630
Income. Interest from loans (other than to participants)	2022-06-21	$0
Interest earned on other investments	2022-06-21	$0
Income. Interest from US Government securities	2022-06-21	$0
Income. Interest from corporate debt instruments	2022-06-21	$0
Value of interest in master investment trust accounts at end of year	2022-06-21	$0
Value of interest in master investment trust accounts at beginning of year	2022-06-21	$0
Value of interest in common/collective trusts at end of year	2022-06-21	$0
Value of interest in common/collective trusts at beginning of year	2022-06-21	$703,815
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-06-21	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-06-21	$843,909
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-06-21	$843,909
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-06-21	$66
Assets. Value of investments in 103.12 investment entities at end of year	2022-06-21	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2022-06-21	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2022-06-21	$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2022-06-21	$232,054
Expenses. Payments to insurance carriers foe the provision of benefits	2022-06-21	$0
Asset value of US Government securities at end of year	2022-06-21	$0
Asset value of US Government securities at beginning of year	2022-06-21	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-06-21	$-4,647,430
Net investment gain/loss from pooled separate accounts	2022-06-21	$0
Net investment gain or loss from common/collective trusts	2022-06-21	$4,964
Net gain/loss from 103.12 investment entities	2022-06-21	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-06-21	No
Was there a failure to transmit to the plan any participant contributions	2022-06-21	No
Has the plan failed to provide any benefit when due under the plan	2022-06-21	No
Assets. Invements in employer securities at end of year	2022-06-21	$0
Assets. Invements in employer securities at beginning of year	2022-06-21	$0
Assets. Value of employer real property at end of year	2022-06-21	$0
Assets. Value of employer real property at beginning of year	2022-06-21	$0
Contributions received in cash from employer	2022-06-21	$0
Employer contributions (assets) at end of year	2022-06-21	$0
Employer contributions (assets) at beginning of year	2022-06-21	$0
Income. Dividends from preferred stock	2022-06-21	$0
Income. Dividends from common stock	2022-06-21	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2022-06-21	$19,651,936
Asset. Corporate debt instrument preferred debt at end of year	2022-06-21	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2022-06-21	$0
Asset. Corporate debt instrument debt (other) at end of year	2022-06-21	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2022-06-21	$0
Contract administrator fees	2022-06-21	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2022-06-21	No
Assets. Corporate common stocks other than exployer securities at end of year	2022-06-21	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2022-06-21	$0
Liabilities. Value of benefit claims payable at end of year	2022-06-21	$0
Liabilities. Value of benefit claims payable at beginning of year	2022-06-21	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2022-06-21	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2022-06-21	$0
Did the plan have assets held for investment	2022-06-21	No
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	2022-06-21	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-06-21	Yes
Aggregate proceeds on sale of assets	2022-06-21	$0
Aggregate carrying amount (costs) on sale of assets	2022-06-21	$0
Liabilities. Value of acquisition indebtedness at end of year	2022-06-21	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2022-06-21	$0
Opinion of an independent qualified public accountant for this plan	2022-06-21	Unqualified
Accountancy firm name	2022-06-21	MCM CPAS & ADVISORS, LLP
Accountancy firm EIN	2022-06-21	271235638
2021 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2021 401k financial data
Unrealized appreciation/depreciation of real estate assets	2021-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2021-12-31	$0
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total transfer of assets to this plan	2021-12-31	$0
Total transfer of assets from this plan	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$0
Expenses. Interest paid	2021-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2021-12-31	$0
Total income from all sources (including contributions)	2021-12-31	$8,514,158
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$2,001,106
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$1,954,472
Expenses. Certain deemed distributions of participant loans	2021-12-31	$0
Value of total corrective distributions	2021-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$1,901,663
Value of total assets at end of year	2021-12-31	$46,251,900
Value of total assets at beginning of year	2021-12-31	$39,738,848
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$46,634
Total income from rents	2021-12-31	$0
Total interest from all sources	2021-12-31	$3,672
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$2,875,740
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$2,875,740
Assets. Real estate other than employer real property at end of year	2021-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2021-12-31	$0
Administrative expenses professional fees incurred	2021-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2021-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2021-12-31	$0
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$500,000
If this is an individual account plan, was there a blackout period	2021-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$1,288,668
Participant contributions at end of year	2021-12-31	$73,500
Participant contributions at beginning of year	2021-12-31	$81,522
Participant contributions at end of year	2021-12-31	$0
Participant contributions at beginning of year	2021-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2021-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2021-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2021-12-31	$217,495
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2021-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$0
Assets. Loans (other than to participants) at end of year	2021-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2021-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$0
Other income not declared elsewhere	2021-12-31	$-44,922
Administrative expenses (other) incurred	2021-12-31	$44,340
Liabilities. Value of operating payables at end of year	2021-12-31	$0
Liabilities. Value of operating payables at beginning of year	2021-12-31	$0
Total non interest bearing cash at end of year	2021-12-31	$0
Total non interest bearing cash at beginning of year	2021-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Income. Non cash contributions	2021-12-31	$0
Value of net income/loss	2021-12-31	$6,513,052
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$46,251,900
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$39,738,848
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Assets. partnership/joint venture interests at end of year	2021-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2021-12-31	$0
Investment advisory and management fees	2021-12-31	$2,294
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-12-31	$44,398,622
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-12-31	$37,362,214
Value of interest in pooled separate accounts at end of year	2021-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2021-12-31	$0
Interest on participant loans	2021-12-31	$3,566
Income. Interest from loans (other than to participants)	2021-12-31	$0
Interest earned on other investments	2021-12-31	$0
Income. Interest from US Government securities	2021-12-31	$0
Income. Interest from corporate debt instruments	2021-12-31	$0
Value of interest in master investment trust accounts at end of year	2021-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2021-12-31	$0
Value of interest in common/collective trusts at end of year	2021-12-31	$703,815
Value of interest in common/collective trusts at beginning of year	2021-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$843,909
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$2,018,136
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$2,018,136
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$106
Assets. Value of investments in 103.12 investment entities at end of year	2021-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2021-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2021-12-31	$232,054
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2021-12-31	$276,976
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$0
Asset value of US Government securities at end of year	2021-12-31	$0
Asset value of US Government securities at beginning of year	2021-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$3,767,809
Net investment gain/loss from pooled separate accounts	2021-12-31	$0
Net investment gain or loss from common/collective trusts	2021-12-31	$10,196
Net gain/loss from 103.12 investment entities	2021-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	No
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Assets. Invements in employer securities at end of year	2021-12-31	$0
Assets. Invements in employer securities at beginning of year	2021-12-31	$0
Assets. Value of employer real property at end of year	2021-12-31	$0
Assets. Value of employer real property at beginning of year	2021-12-31	$0
Contributions received in cash from employer	2021-12-31	$395,500
Employer contributions (assets) at end of year	2021-12-31	$0
Employer contributions (assets) at beginning of year	2021-12-31	$0
Income. Dividends from preferred stock	2021-12-31	$0
Income. Dividends from common stock	2021-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2021-12-31	$1,954,472
Asset. Corporate debt instrument preferred debt at end of year	2021-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2021-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2021-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2021-12-31	$0
Contract administrator fees	2021-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2021-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2021-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2021-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2021-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2021-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2021-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2021-12-31	$0
Did the plan have assets held for investment	2021-12-31	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	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Aggregate proceeds on sale of assets	2021-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2021-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2021-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2021-12-31	$0
2020 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets	2020-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2020-12-31	$0
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total transfer of assets to this plan	2020-12-31	$0
Total transfer of assets from this plan	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$0
Expenses. Interest paid	2020-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2020-12-31	$0
Total income from all sources (including contributions)	2020-12-31	$7,981,142
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$2,377,663
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$2,343,426
Expenses. Certain deemed distributions of participant loans	2020-12-31	$1,167
Value of total corrective distributions	2020-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$1,658,019
Value of total assets at end of year	2020-12-31	$39,738,848
Value of total assets at beginning of year	2020-12-31	$34,135,369
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$33,070
Total income from rents	2020-12-31	$0
Total interest from all sources	2020-12-31	$7,312
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$1,474,546
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$1,474,546
Assets. Real estate other than employer real property at end of year	2020-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2020-12-31	$0
Administrative expenses professional fees incurred	2020-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2020-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2020-12-31	$0
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$500,000
If this is an individual account plan, was there a blackout period	2020-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$1,173,761
Participant contributions at end of year	2020-12-31	$81,522
Participant contributions at beginning of year	2020-12-31	$104,440
Participant contributions at end of year	2020-12-31	$0
Participant contributions at beginning of year	2020-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2020-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2020-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2020-12-31	$107,181
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2020-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$0
Assets. Loans (other than to participants) at end of year	2020-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2020-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$0
Other income not declared elsewhere	2020-12-31	$0
Administrative expenses (other) incurred	2020-12-31	$31,951
Liabilities. Value of operating payables at end of year	2020-12-31	$0
Liabilities. Value of operating payables at beginning of year	2020-12-31	$0
Total non interest bearing cash at end of year	2020-12-31	$0
Total non interest bearing cash at beginning of year	2020-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Income. Non cash contributions	2020-12-31	$0
Value of net income/loss	2020-12-31	$5,603,479
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$39,738,848
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$34,135,369
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Assets. partnership/joint venture interests at end of year	2020-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2020-12-31	$0
Investment advisory and management fees	2020-12-31	$1,119
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$37,362,214
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$32,448,103
Value of interest in pooled separate accounts at end of year	2020-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2020-12-31	$0
Interest on participant loans	2020-12-31	$4,492
Income. Interest from loans (other than to participants)	2020-12-31	$0
Interest earned on other investments	2020-12-31	$0
Income. Interest from US Government securities	2020-12-31	$0
Income. Interest from corporate debt instruments	2020-12-31	$0
Value of interest in master investment trust accounts at end of year	2020-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2020-12-31	$0
Value of interest in common/collective trusts at end of year	2020-12-31	$0
Value of interest in common/collective trusts at beginning of year	2020-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-12-31	$2,018,136
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-12-31	$879,674
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-12-31	$879,674
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$2,820
Assets. Value of investments in 103.12 investment entities at end of year	2020-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2020-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-12-31	$276,976
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-12-31	$703,152
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$48,263
Asset value of US Government securities at end of year	2020-12-31	$0
Asset value of US Government securities at beginning of year	2020-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$4,841,265
Net investment gain/loss from pooled separate accounts	2020-12-31	$0
Net investment gain or loss from common/collective trusts	2020-12-31	$0
Net gain/loss from 103.12 investment entities	2020-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	No
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Assets. Invements in employer securities at end of year	2020-12-31	$0
Assets. Invements in employer securities at beginning of year	2020-12-31	$0
Assets. Value of employer real property at end of year	2020-12-31	$0
Assets. Value of employer real property at beginning of year	2020-12-31	$0
Contributions received in cash from employer	2020-12-31	$377,077
Employer contributions (assets) at end of year	2020-12-31	$0
Employer contributions (assets) at beginning of year	2020-12-31	$0
Income. Dividends from preferred stock	2020-12-31	$0
Income. Dividends from common stock	2020-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-12-31	$2,295,163
Asset. Corporate debt instrument preferred debt at end of year	2020-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2020-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2020-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2020-12-31	$0
Contract administrator fees	2020-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2020-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2020-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2020-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2020-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2020-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2020-12-31	$0
Did the plan have assets held for investment	2020-12-31	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	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Aggregate proceeds on sale of assets	2020-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2020-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2020-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2020-12-31	$0
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	MCM CPAS & ADVISORS, LLP
Accountancy firm EIN	2020-12-31	271235638
2019 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2019 401k financial data
Unrealized appreciation/depreciation of real estate assets	2019-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2019-12-31	$0
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total transfer of assets to this plan	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$0
Expenses. Interest paid	2019-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2019-12-31	$0
Total income from all sources (including contributions)	2019-12-31	$8,522,845
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$2,011,074
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,979,403
Expenses. Certain deemed distributions of participant loans	2019-12-31	$0
Value of total corrective distributions	2019-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,564,497
Value of total assets at end of year	2019-12-31	$34,135,369
Value of total assets at beginning of year	2019-12-31	$27,623,598
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$31,671
Total income from rents	2019-12-31	$0
Total interest from all sources	2019-12-31	$29,601
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$1,491,214
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$1,491,214
Assets. Real estate other than employer real property at end of year	2019-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2019-12-31	$0
Administrative expenses professional fees incurred	2019-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2019-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2019-12-31	$0
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$500,000
If this is an individual account plan, was there a blackout period	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$1,075,864
Participant contributions at end of year	2019-12-31	$104,440
Participant contributions at beginning of year	2019-12-31	$88,252
Participant contributions at end of year	2019-12-31	$0
Participant contributions at beginning of year	2019-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2019-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2019-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2019-12-31	$113,058
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$0
Assets. Loans (other than to participants) at end of year	2019-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$0
Other income not declared elsewhere	2019-12-31	$26,000
Administrative expenses (other) incurred	2019-12-31	$31,073
Liabilities. Value of operating payables at end of year	2019-12-31	$0
Liabilities. Value of operating payables at beginning of year	2019-12-31	$0
Total non interest bearing cash at end of year	2019-12-31	$0
Total non interest bearing cash at beginning of year	2019-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Income. Non cash contributions	2019-12-31	$0
Value of net income/loss	2019-12-31	$6,511,771
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$34,135,369
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$27,623,598
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Assets. partnership/joint venture interests at end of year	2019-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2019-12-31	$0
Investment advisory and management fees	2019-12-31	$598
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$32,448,103
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$24,202,948
Value of interest in pooled separate accounts at end of year	2019-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2019-12-31	$0
Interest on participant loans	2019-12-31	$4,132
Income. Interest from loans (other than to participants)	2019-12-31	$0
Interest earned on other investments	2019-12-31	$0
Income. Interest from US Government securities	2019-12-31	$0
Income. Interest from corporate debt instruments	2019-12-31	$0
Value of interest in master investment trust accounts at end of year	2019-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2019-12-31	$0
Value of interest in common/collective trusts at end of year	2019-12-31	$0
Value of interest in common/collective trusts at beginning of year	2019-12-31	$524,013
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-12-31	$879,674
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-12-31	$2,131,233
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-12-31	$2,131,233
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$25,469
Assets. Value of investments in 103.12 investment entities at end of year	2019-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2019-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-12-31	$703,152
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-12-31	$677,152
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$1,837
Asset value of US Government securities at end of year	2019-12-31	$0
Asset value of US Government securities at beginning of year	2019-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$5,405,941
Net investment gain/loss from pooled separate accounts	2019-12-31	$0
Net investment gain or loss from common/collective trusts	2019-12-31	$5,592
Net gain/loss from 103.12 investment entities	2019-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Assets. Invements in employer securities at end of year	2019-12-31	$0
Assets. Invements in employer securities at beginning of year	2019-12-31	$0
Assets. Value of employer real property at end of year	2019-12-31	$0
Assets. Value of employer real property at beginning of year	2019-12-31	$0
Contributions received in cash from employer	2019-12-31	$375,575
Employer contributions (assets) at end of year	2019-12-31	$0
Employer contributions (assets) at beginning of year	2019-12-31	$0
Income. Dividends from preferred stock	2019-12-31	$0
Income. Dividends from common stock	2019-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-12-31	$1,977,566
Asset. Corporate debt instrument preferred debt at end of year	2019-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2019-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2019-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2019-12-31	$0
Contract administrator fees	2019-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-12-31	No
Assets. Corporate common stocks other than exployer securities at end of year	2019-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2019-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2019-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2019-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2019-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2019-12-31	$0
Did the plan have assets held for investment	2019-12-31	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	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Aggregate proceeds on sale of assets	2019-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2019-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2019-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2019-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2019-12-31	Disclaimer
Accountancy firm name	2019-12-31	MCM CPAS & ADVISORS, LLP
Accountancy firm EIN	2019-12-31	271235638
2018 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2018 401k financial data
Unrealized appreciation/depreciation of real estate assets	2018-12-31	$0
Unrealized appreciation/depreciation of other (non real estate) assets	2018-12-31	$0
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total transfer of assets to this plan	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Expenses. Interest paid	2018-12-31	$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102	2018-12-31	$0
Total income from all sources (including contributions)	2018-12-31	$261,132
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$3,781,212
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$3,749,348
Expenses. Certain deemed distributions of participant loans	2018-12-31	$0
Value of total corrective distributions	2018-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,284,467
Value of total assets at end of year	2018-12-31	$27,623,598
Value of total assets at beginning of year	2018-12-31	$31,143,678
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$31,864
Total income from rents	2018-12-31	$0
Total interest from all sources	2018-12-31	$14,496
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$1,523,709
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$1,523,709
Assets. Real estate other than employer real property at end of year	2018-12-31	$0
Assets. Real estate other than employer real property at beginning of year	2018-12-31	$0
Administrative expenses professional fees incurred	2018-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at end of year	2018-12-31	$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year	2018-12-31	$0
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$500,000
If this is an individual account plan, was there a blackout period	2018-12-31	Yes
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$973,618
Participant contributions at end of year	2018-12-31	$88,252
Participant contributions at beginning of year	2018-12-31	$44,140
Participant contributions at end of year	2018-12-31	$0
Participant contributions at beginning of year	2018-12-31	$0
Assets. Other investments not covered elsewhere at end of year	2018-12-31	$0
Assets. Other investments not covered elsewhere at beginning of year	2018-12-31	$0
Income. Received or receivable in cash from other sources (including rollovers)	2018-12-31	$16,759
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2018-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$0
Assets. Loans (other than to participants) at end of year	2018-12-31	$0
Assets. Loans (other than to participants) at beginning of year	2018-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$0
Other income not declared elsewhere	2018-12-31	$36,360
Administrative expenses (other) incurred	2018-12-31	$31,864
Liabilities. Value of operating payables at end of year	2018-12-31	$0
Liabilities. Value of operating payables at beginning of year	2018-12-31	$0
Total non interest bearing cash at end of year	2018-12-31	$0
Total non interest bearing cash at beginning of year	2018-12-31	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Income. Non cash contributions	2018-12-31	$0
Value of net income/loss	2018-12-31	$-3,520,080
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$27,623,598
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$31,143,678
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Assets. partnership/joint venture interests at end of year	2018-12-31	$0
Assets. partnership/joint venture interests at beginning of year	2018-12-31	$0
Investment advisory and management fees	2018-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$24,202,948
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$29,788,995
Value of interest in pooled separate accounts at end of year	2018-12-31	$0
Value of interest in pooled separate accounts at beginning of year	2018-12-31	$0
Interest on participant loans	2018-12-31	$2,714
Income. Interest from loans (other than to participants)	2018-12-31	$0
Interest earned on other investments	2018-12-31	$0
Income. Interest from US Government securities	2018-12-31	$0
Income. Interest from corporate debt instruments	2018-12-31	$0
Value of interest in master investment trust accounts at end of year	2018-12-31	$0
Value of interest in master investment trust accounts at beginning of year	2018-12-31	$0
Value of interest in common/collective trusts at end of year	2018-12-31	$524,013
Value of interest in common/collective trusts at beginning of year	2018-12-31	$589,737
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$2,131,233
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$11,782
Assets. Value of investments in 103.12 investment entities at end of year	2018-12-31	$0
Assets. Value of investments in 103.12 investment entities at beginning of year	2018-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-12-31	$677,152
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-12-31	$640,792
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$10,549
Asset value of US Government securities at end of year	2018-12-31	$0
Asset value of US Government securities at beginning of year	2018-12-31	$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-2,637,799
Net investment gain/loss from pooled separate accounts	2018-12-31	$0
Net investment gain or loss from common/collective trusts	2018-12-31	$39,899
Net gain/loss from 103.12 investment entities	2018-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Assets. Invements in employer securities at end of year	2018-12-31	$0
Assets. Invements in employer securities at beginning of year	2018-12-31	$0
Assets. Value of employer real property at end of year	2018-12-31	$0
Assets. Value of employer real property at beginning of year	2018-12-31	$0
Contributions received in cash from employer	2018-12-31	$294,090
Employer contributions (assets) at end of year	2018-12-31	$0
Employer contributions (assets) at beginning of year	2018-12-31	$80,014
Income. Dividends from preferred stock	2018-12-31	$0
Income. Dividends from common stock	2018-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-12-31	$3,738,799
Asset. Corporate debt instrument preferred debt at end of year	2018-12-31	$0
Asset. Corporate debt instrument preferred debt at beginning of year	2018-12-31	$0
Asset. Corporate debt instrument debt (other) at end of year	2018-12-31	$0
Asset. Corporate debt instrument debt (other) at beginning of year	2018-12-31	$0
Contract administrator fees	2018-12-31	$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-12-31	Yes
Assets. Corporate common stocks other than exployer securities at end of year	2018-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2018-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2018-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2018-12-31	$0
Assets. Value of buildings and other operty used in plan operation at end of year	2018-12-31	$0
Assets. Value of buildings and other operty used in plan operation at beginning of year	2018-12-31	$0
Did the plan have assets held for investment	2018-12-31	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	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Aggregate proceeds on sale of assets	2018-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2018-12-31	$0
Liabilities. Value of acquisition indebtedness at end of year	2018-12-31	$0
Liabilities. Value of acquisition indebtedness at beginning of year	2018-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2018-12-31	Disclaimer
Accountancy firm name	2018-12-31	MCM CPAS & ADVISORS, LLP
Accountancy firm EIN	2018-12-31	271235638
2017 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2017-12-31	$31,377
Total unrealized appreciation/depreciation of assets	2017-12-31	$31,377
Total income from all sources (including contributions)	2017-12-31	$5,977,098
Total loss/gain on sale of assets	2017-12-31	$524,490
Total of all expenses incurred	2017-12-31	$2,570,780
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$2,493,957
Value of total corrective distributions	2017-12-31	$17,535
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,286,142
Value of total assets at end of year	2017-12-31	$31,143,678
Value of total assets at beginning of year	2017-12-31	$27,737,360
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$59,288
Total interest from all sources	2017-12-31	$1,419
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$1,639,347
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$1,639,347
Administrative expenses professional fees incurred	2017-12-31	$8,400
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$500,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2017-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$955,680
Participant contributions at end of year	2017-12-31	$44,140
Participant contributions at beginning of year	2017-12-31	$63,434
Income. Received or receivable in cash from other sources (including rollovers)	2017-12-31	$24,737
Other income not declared elsewhere	2017-12-31	$40,274
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$3,406,318
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$31,143,678
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$27,737,360
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$29,788,995
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$24,341,606
Interest on participant loans	2017-12-31	$1,419
Value of interest in common/collective trusts at end of year	2017-12-31	$589,737
Value of interest in common/collective trusts at beginning of year	2017-12-31	$2,566,997
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-12-31	$640,792
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-12-31	$685,566
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$2,585
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$2,445,584
Net investment gain or loss from common/collective trusts	2017-12-31	$8,465
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$305,725
Employer contributions (assets) at end of year	2017-12-31	$80,014
Employer contributions (assets) at beginning of year	2017-12-31	$79,757
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-12-31	$2,491,372
Contract administrator fees	2017-12-31	$50,888
Did the plan have assets held for investment	2017-12-31	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	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Aggregate proceeds on sale of assets	2017-12-31	$12,745,603
Aggregate carrying amount (costs) on sale of assets	2017-12-31	$12,221,113
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2017-12-31	Disclaimer
Accountancy firm name	2017-12-31	MCM CPAS & ADVISORS, LLP
Accountancy firm EIN	2017-12-31	271235638
2016 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2016-12-31	$1,490
Total unrealized appreciation/depreciation of assets	2016-12-31	$1,490
Total income from all sources (including contributions)	2016-12-31	$3,343,918
Total loss/gain on sale of assets	2016-12-31	$-39,490
Total of all expenses incurred	2016-12-31	$838,159
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$762,438
Value of total corrective distributions	2016-12-31	$21,700
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,305,545
Value of total assets at end of year	2016-12-31	$27,737,360
Value of total assets at beginning of year	2016-12-31	$25,231,601
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$54,021
Total interest from all sources	2016-12-31	$1,934
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$1,077,191
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$1,077,191
Administrative expenses professional fees incurred	2016-12-31	$54,021
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$970,575
Participant contributions at end of year	2016-12-31	$63,434
Participant contributions at beginning of year	2016-12-31	$69,085
Income. Received or receivable in cash from other sources (including rollovers)	2016-12-31	$1,968
Other income not declared elsewhere	2016-12-31	$31,574
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$2,505,759
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$27,737,360
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$25,231,601
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$24,341,606
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$21,816,182
Interest on participant loans	2016-12-31	$1,934
Value of interest in common/collective trusts at end of year	2016-12-31	$2,566,997
Value of interest in common/collective trusts at beginning of year	2016-12-31	$2,616,598
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-12-31	$685,566
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-12-31	$639,860
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$25,482
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$930,822
Net investment gain or loss from common/collective trusts	2016-12-31	$34,852
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$333,002
Employer contributions (assets) at end of year	2016-12-31	$79,757
Employer contributions (assets) at beginning of year	2016-12-31	$89,876
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$736,956
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Aggregate proceeds on sale of assets	2016-12-31	$7,096,883
Aggregate carrying amount (costs) on sale of assets	2016-12-31	$7,136,373
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2016-12-31	Disclaimer
Accountancy firm name	2016-12-31	MOUNTJOY CHILTON MEDLEY LLP
Accountancy firm EIN	2016-12-31	271235638
2015 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2015 401k financial data
Total income from all sources (including contributions)	2015-12-31	$1,535,561
Total of all expenses incurred	2015-12-31	$673,007
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$587,169
Value of total corrective distributions	2015-12-31	$27,189
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$1,356,476
Value of total assets at end of year	2015-12-31	$25,231,601
Value of total assets at beginning of year	2015-12-31	$24,369,047
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$58,649
Total interest from all sources	2015-12-31	$2,085
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$1,258,370
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$1,258,370
Administrative expenses professional fees incurred	2015-12-31	$58,649
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$961,408
Participant contributions at end of year	2015-12-31	$69,085
Participant contributions at beginning of year	2015-12-31	$82,072
Income. Received or receivable in cash from other sources (including rollovers)	2015-12-31	$63,889
Other income not declared elsewhere	2015-12-31	$33,548
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$862,554
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$25,231,601
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$24,369,047
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$21,816,182
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$21,564,335
Interest on participant loans	2015-12-31	$2,085
Value of interest in common/collective trusts at end of year	2015-12-31	$2,616,598
Value of interest in common/collective trusts at beginning of year	2015-12-31	$2,030,718
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-12-31	$639,860
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-12-31	$610,512
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$10,574
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-1,117,929
Net investment gain or loss from common/collective trusts	2015-12-31	$3,011
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$331,179
Employer contributions (assets) at end of year	2015-12-31	$89,876
Employer contributions (assets) at beginning of year	2015-12-31	$81,410
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$576,595
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2015-12-31	Disclaimer
Accountancy firm name	2015-12-31	MOUNTJOY CHILTON MEDLEY LLP
Accountancy firm EIN	2015-12-31	271235638
2014 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2014-12-31	$81,051
Total unrealized appreciation/depreciation of assets	2014-12-31	$81,051
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$0
Total income from all sources (including contributions)	2014-12-31	$2,724,609
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$1,594,172
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$1,511,229
Value of total corrective distributions	2014-12-31	$35,619
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$1,185,690
Value of total assets at end of year	2014-12-31	$24,369,047
Value of total assets at beginning of year	2014-12-31	$23,238,610
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$47,324
Total interest from all sources	2014-12-31	$2,846
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$1,342,096
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$1,342,096
Administrative expenses professional fees incurred	2014-12-31	$47,324
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$889,741
Participant contributions at end of year	2014-12-31	$82,072
Participant contributions at beginning of year	2014-12-31	$101,143
Participant contributions at beginning of year	2014-12-31	$45
Other income not declared elsewhere	2014-12-31	$32,757
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$1,130,437
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$24,369,047
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$23,238,610
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$21,564,335
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$20,135,132
Interest on participant loans	2014-12-31	$2,846
Value of interest in common/collective trusts at end of year	2014-12-31	$2,030,718
Value of interest in common/collective trusts at beginning of year	2014-12-31	$2,375,678
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-12-31	$610,512
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-12-31	$586,395
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$6,714
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$61,231
Net investment gain or loss from common/collective trusts	2014-12-31	$18,938
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$295,949
Employer contributions (assets) at end of year	2014-12-31	$81,410
Employer contributions (assets) at beginning of year	2014-12-31	$40,217
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$1,504,515
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Aggregate proceeds on sale of assets	2014-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2014-12-31	$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2014-12-31	Disclaimer
Accountancy firm name	2014-12-31	MOUNTJOY CHILTON MEDLEY LLP
Accountancy firm EIN	2014-12-31	271235638
2013 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-12-31	$1,654
Total unrealized appreciation/depreciation of assets	2013-12-31	$1,654
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$0
Total income from all sources (including contributions)	2013-12-31	$4,934,839
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$1,725,212
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$1,677,540
Value of total corrective distributions	2013-12-31	$12,648
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$1,008,011
Value of total assets at end of year	2013-12-31	$23,238,610
Value of total assets at beginning of year	2013-12-31	$20,028,983
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$35,024
Total interest from all sources	2013-12-31	$3,360
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$1,188,806
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$1,188,806
Administrative expenses professional fees incurred	2013-12-31	$35,024
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$801,467
Participant contributions at end of year	2013-12-31	$101,143
Participant contributions at beginning of year	2013-12-31	$93,386
Participant contributions at end of year	2013-12-31	$45
Participant contributions at beginning of year	2013-12-31	$23,608
Income. Received or receivable in cash from other sources (including rollovers)	2013-12-31	$73,599
Other income not declared elsewhere	2013-12-31	$28,614
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$3,209,627
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$23,238,610
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$20,028,983
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$20,135,132
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$15,847,040
Interest on participant loans	2013-12-31	$3,360
Value of interest in common/collective trusts at end of year	2013-12-31	$2,375,678
Value of interest in common/collective trusts at beginning of year	2013-12-31	$3,448,075
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-12-31	$586,395
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-12-31	$584,741
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$16,850
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$2,748,706
Net investment gain or loss from common/collective trusts	2013-12-31	$-44,312
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$132,945
Employer contributions (assets) at end of year	2013-12-31	$40,217
Employer contributions (assets) at beginning of year	2013-12-31	$32,133
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$1,660,690
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	Yes
Opinion of an independent qualified public accountant for this plan	2013-12-31	Disclaimer
Accountancy firm name	2013-12-31	MOUNTJOY CHILTON MEDLEY LLP
Accountancy firm EIN	2013-12-31	271235638
2012 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT 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	$2,884,546
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$675,592
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$644,397
Value of total corrective distributions	2012-12-31	$12,333
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$896,783
Value of total assets at end of year	2012-12-31	$20,028,983
Value of total assets at beginning of year	2012-12-31	$17,820,029
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$18,862
Total interest from all sources	2012-12-31	$3,021
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$549,383
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$549,383
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$500,000
If this is an individual account plan, was there a blackout period	2012-12-31	Yes
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	$752,836
Participant contributions at end of year	2012-12-31	$93,386
Participant contributions at beginning of year	2012-12-31	$99,998
Participant contributions at end of year	2012-12-31	$23,608
Participant contributions at beginning of year	2012-12-31	$29,114
Income. Received or receivable in cash from other sources (including rollovers)	2012-12-31	$12,802
Other income not declared elsewhere	2012-12-31	$47,296
Administrative expenses (other) incurred	2012-12-31	$18,862
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	$2,208,954
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$20,028,983
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$17,820,029
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$15,847,040
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$14,277,712
Interest on participant loans	2012-12-31	$3,021
Value of interest in common/collective trusts at end of year	2012-12-31	$3,448,075
Value of interest in common/collective trusts at beginning of year	2012-12-31	$2,830,451
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2012-12-31	$584,741
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2012-12-31	$549,736
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$13,643
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$1,307,051
Net investment gain or loss from common/collective trusts	2012-12-31	$81,012
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
Contributions received in cash from employer	2012-12-31	$131,145
Employer contributions (assets) at end of year	2012-12-31	$32,133
Employer contributions (assets) at beginning of year	2012-12-31	$33,018
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$630,754
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-12-31	Yes
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	MOUNTJOY CHILTON MEDLEY LLP
Accountancy firm EIN	2012-12-31	271235638
2011 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT 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	$654,773
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$1,390,618
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$1,360,993
Value of total corrective distributions	2011-12-31	$12,626
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$902,503
Value of total assets at end of year	2011-12-31	$17,820,029
Value of total assets at beginning of year	2011-12-31	$18,555,874
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$16,999
Total interest from all sources	2011-12-31	$3,168
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$444,638
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$444,638
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
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	$774,769
Participant contributions at end of year	2011-12-31	$99,998
Participant contributions at beginning of year	2011-12-31	$105,684
Participant contributions at end of year	2011-12-31	$29,114
Other income not declared elsewhere	2011-12-31	$42,236
Administrative expenses (other) incurred	2011-12-31	$16,999
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	$-735,845
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$17,820,029
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$18,555,874
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$14,277,712
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$15,396,092
Interest on participant loans	2011-12-31	$3,168
Value of interest in common/collective trusts at end of year	2011-12-31	$2,830,451
Value of interest in common/collective trusts at beginning of year	2011-12-31	$2,507,108
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2011-12-31	$549,736
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2011-12-31	$513,782
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$21,600
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$-822,877
Net investment gain or loss from common/collective trusts	2011-12-31	$85,105
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
Contributions received in cash from employer	2011-12-31	$127,734
Employer contributions (assets) at end of year	2011-12-31	$33,018
Employer contributions (assets) at beginning of year	2011-12-31	$33,208
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$1,339,393
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
Aggregate proceeds on sale of assets	2011-12-31	$0
Aggregate carrying amount (costs) on sale of assets	2011-12-31	$0
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	MOUNTJOY CHILTON MEDLEY LLP
Accountancy firm EIN	2011-12-31	271235638
2010 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT 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	$2,886,473
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$471,754
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$442,074
Value of total corrective distributions	2010-12-31	$9,389
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$888,132
Value of total assets at end of year	2010-12-31	$18,555,874
Value of total assets at beginning of year	2010-12-31	$16,141,155
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$20,291
Total interest from all sources	2010-12-31	$3,129
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$271,502
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2010-12-31	$271,502
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
If this is an individual account plan, was there a blackout period	2010-12-31	Yes
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	$754,674
Participant contributions at end of year	2010-12-31	$105,684
Participant contributions at beginning of year	2010-12-31	$75,579
Participant contributions at beginning of year	2010-12-31	$23,792
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$3,675
Other income not declared elsewhere	2010-12-31	$35,002
Administrative expenses (other) incurred	2010-12-31	$20,291
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	$2,414,719
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$18,555,874
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$16,141,155
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
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$15,396,092
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$13,328,813
Interest on participant loans	2010-12-31	$3,129
Value of interest in common/collective trusts at end of year	2010-12-31	$2,507,108
Value of interest in common/collective trusts at beginning of year	2010-12-31	$2,198,623
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2010-12-31	$513,782
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2010-12-31	$481,360
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$12,105
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$1,591,812
Net investment gain or loss from common/collective trusts	2010-12-31	$96,896
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
Contributions received in cash from employer	2010-12-31	$129,783
Employer contributions (assets) at end of year	2010-12-31	$33,208
Employer contributions (assets) at beginning of year	2010-12-31	$32,988
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$429,969
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2010-12-31	Yes
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	MOUNTJOY CHILTON MEDLEY LLP
Accountancy firm EIN	2010-12-31	271235638
2009 : UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT 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 UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN

2022: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	Yes
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Submission has been amended	Yes
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	No
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT 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 – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT 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 – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT 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 funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT 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: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT 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
2010: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: UNDERWRITERS SAFETY & CLAIMS, INC. RETIREMENT 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

GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	04953467
Policy instance	1
Insurance contract or identification number 04953467 Number of Individuals Covered 1 Insurance policy start date 2022-01-01 Insurance policy end date 2022-06-21 Are there contracts with allocated funds for individual policies? 0 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? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes 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
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	04953467
Policy instance	1
Insurance contract or identification number 04953467 Number of Individuals Covered 1 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Contract purchased, in whole or in part, to distribute benefits from a terminating plan No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	04953417
Policy instance	1
Insurance contract or identification number 04953417 Number of Individuals Covered 0 Insurance policy start date 2020-01-01 Insurance policy end date 2020-06-30 Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	T13096
Policy instance	4
Insurance contract or identification number T13096 Number of Individuals Covered 0 Insurance policy start date 2020-01-01 Insurance policy end date 2020-01-31 Are there contracts with allocated funds for individual policies? 0 Are there contracts with allocated funds for types other than group deferred annuity or individual? 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? No Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes 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
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	04953467
Policy instance	3
Insurance contract or identification number 04953467 Number of Individuals Covered 1 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	04879974
Policy instance	2
Insurance contract or identification number 04879974 Number of Individuals Covered 0 Insurance policy start date 2020-01-01 Insurance policy end date 2020-06-30 Health Insurance Welfare Benefit No Dental Insurance Welfare Benefit No Vision Insurance Welfare Benefit No Life Insurance Welfare Benefit Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	04953467
Policy instance	3
Insurance contract or identification number 04953467 Number of Individuals Covered 1 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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? No 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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	04953417
Policy instance	1
Insurance contract or identification number 04953417 Number of Individuals Covered 1 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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? No 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 $0 Amount paid for insurance broker fees 0
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	04879974
Policy instance	2
Insurance contract or identification number 04879974 Number of Individuals Covered 1 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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? No 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 $0 Amount paid for insurance broker fees 0
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	T13096
Policy instance	4
Insurance contract or identification number T13096 Number of Individuals Covered 1 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $55 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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? No 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 $55 Amount paid for insurance broker fees 0
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	04879974
Policy instance	4
Insurance contract or identification number 04879974 Number of Individuals Covered 1 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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? No 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 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 $0 Amount paid for insurance broker fees 0
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	04953467
Policy instance	1
Insurance contract or identification number 04953467 Number of Individuals Covered 1 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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? No 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 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 $0 Amount paid for insurance broker fees 0
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	04953417
Policy instance	2
Insurance contract or identification number 04953417 Number of Individuals Covered 1 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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? No 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 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 $0 Amount paid for insurance broker fees 0
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	T13096
Policy instance	3
Insurance contract or identification number T13096 Number of Individuals Covered 0 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $55 Total amount of fees paid to insurance company USD $0 Are there contracts with allocated funds for individual policies? 0 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? No 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 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 $55 Amount paid for insurance broker fees 0
PHOENIX LIFE MUTUAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	2581953
Policy instance	4
Insurance contract or identification number 2581953 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Insurance broker organization code? 3 Insurance broker name CHARLES A HODGIN
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	10323
Policy instance	3
Insurance contract or identification number 10323 Number of Individuals Covered 2 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000115
Policy instance	2
Insurance contract or identification number U000115 Number of Individuals Covered 1 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	00709
Policy instance	1
Insurance contract or identification number 00709 Number of Individuals Covered 1 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	10323
Policy instance	4
Insurance contract or identification number 10323 Number of Individuals Covered 2 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0
PHOENIX LIFE MUTUAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	2581953
Policy instance	5
Insurance contract or identification number 2581953 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $55 Total amount of fees paid to insurance company USD $0 Commission paid to Insurance Broker USD $55 Insurance broker organization code? 3 Insurance broker name CHARLES A HODGIN
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000523
Policy instance	3
Insurance contract or identification number U000523 Number of Individuals Covered 1 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	00709
Policy instance	1
Insurance contract or identification number 00709 Number of Individuals Covered 2 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000115
Policy instance	2
Insurance contract or identification number U000115 Number of Individuals Covered 1 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000523
Policy instance	3
Insurance contract or identification number U000523 Number of Individuals Covered 1 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	00709
Policy instance	1
Insurance contract or identification number 00709 Number of Individuals Covered 2 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000115
Policy instance	2
Insurance contract or identification number U000115 Number of Individuals Covered 1 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	10323
Policy instance	4
Insurance contract or identification number 10323 Number of Individuals Covered 2 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
PHOENIX LIFE MUTUAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	2581953
Policy instance	5
Insurance contract or identification number 2581953 Number of Individuals Covered 1 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $55 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? No 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 $55 Insurance broker organization code? 3 Insurance broker name CHARLES A HODGIN
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000115
Policy instance	5
Insurance contract or identification number U000115 Number of Individuals Covered 1 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
PHOENIX LIFE MUTUAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	2581953
Policy instance	3
Insurance contract or identification number 2581953 Number of Individuals Covered 1 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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 Insurance broker organization code? 3 Insurance broker name CHARLES A HODGIN
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000523
Policy instance	2
Insurance contract or identification number U000523 Number of Individuals Covered 1 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	10323
Policy instance	1
Insurance contract or identification number 10323 Number of Individuals Covered 2 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	00709
Policy instance	4
Insurance contract or identification number 00709 Number of Individuals Covered 2 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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 Insurance broker organization code? 3 Insurance broker name CHARLES A. HODGIN
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	10323
Policy instance	5
Insurance contract or identification number 10323 Number of Individuals Covered 2 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000523
Policy instance	3
Insurance contract or identification number U000523 Number of Individuals Covered 1 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	00709
Policy instance	4
Insurance contract or identification number 00709 Number of Individuals Covered 2 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $248 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? No 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 $248 Insurance broker organization code? 3 Insurance broker name CHARLES A. HODGIN
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000115
Policy instance	1
Insurance contract or identification number U000115 Number of Individuals Covered 1 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
PHOENIX LIFE MUTUAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	2581953
Policy instance	2
Insurance contract or identification number 2581953 Number of Individuals Covered 1 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 Total amount of commissions paid to insurance broker USD $55 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? No 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 $55 Insurance broker organization code? 3 Insurance broker name CHARLES A HODGIN
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	10323
Policy instance	4
Insurance contract or identification number 10323 Number of Individuals Covered 2 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	00709
Policy instance	1
Insurance contract or identification number 00709 Number of Individuals Covered 2 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $315 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? No 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
PHOENIX LIFE MUTUAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	2581953
Policy instance	2
Insurance contract or identification number 2581953 Number of Individuals Covered 1 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $55 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? No 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
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000115
Policy instance	3
Insurance contract or identification number U000115 Number of Individuals Covered 1 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000523
Policy instance	5
Insurance contract or identification number U000523 Number of Individuals Covered 1 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	10323
Policy instance	2
Insurance contract or identification number 10323 Number of Individuals Covered 2 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
PHOENIX LIFE MUTUAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	2581953
Policy instance	3
Insurance contract or identification number 2581953 Number of Individuals Covered 1 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $55 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? No 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
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000115
Policy instance	4
Insurance contract or identification number U000115 Number of Individuals Covered 1 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
PHOENIX LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 67814 )
Policy contract number	U000523
Policy instance	5
Insurance contract or identification number U000523 Number of Individuals Covered 1 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $0 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? No 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
GREAT WEST LIFE (National Association of Insurance Commissioners NAIC id number: 80705 )
Policy contract number	00709
Policy instance	1
Insurance contract or identification number 00709 Number of Individuals Covered 2 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $287 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? No 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