401k Plan data: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN plan

COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 401k Plan overview

Plan Name	COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN
Plan identification number	001

COPELANDS EMPLOYEE INCENTIVE SAVINGS 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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

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

Company Name: COPELANDS, INC.

Employer identification number (EIN): 620721221

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 MIKE COPELAND 2023-04-14 MIKE COPELAND 2023-04-14
001 2021-01-01 MIKE COPELAND 2022-05-03 MIKE COPELAND 2022-05-03
001 2020-01-01 MIKE COPELAND 2021-04-12 MIKE COPELAND 2021-04-12
001 2019-01-01 MIKE COPELAND 2020-06-01 MIKE COPELAND 2020-06-01
001 2018-01-01 MIKE COPELAND 2019-04-18 MIKE COPELAND 2019-04-18
001 2017-01-01 MIKE COPELAND 2018-07-19 MIKE COPELAND 2018-07-19
001 2016-01-01 DAVID M. COPELAND
001 2015-01-01 DAVID M. COPELAND
001 2014-01-01 DAVID M. COPELAND
001 2013-01-01 MIKE COPELAND
001 2012-01-01 MIKE COPELAND
001 2011-01-01 MIKE COPELAND
001 2010-01-01 MIKE COPELAND

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	MIKE COPELAND	2023-04-14	MIKE COPELAND	2023-04-14
001	2021-01-01	MIKE COPELAND	2022-05-03	MIKE COPELAND	2022-05-03
001	2020-01-01	MIKE COPELAND	2021-04-12	MIKE COPELAND	2021-04-12
001	2019-01-01	MIKE COPELAND	2020-06-01	MIKE COPELAND	2020-06-01
001	2018-01-01	MIKE COPELAND	2019-04-18	MIKE COPELAND	2019-04-18
001	2017-01-01	MIKE COPELAND	2018-07-19	MIKE COPELAND	2018-07-19
001	2016-01-01	DAVID M. COPELAND
001	2015-01-01	DAVID M. COPELAND
001	2014-01-01	DAVID M. COPELAND
001	2013-01-01	MIKE COPELAND
001	2012-01-01	MIKE COPELAND
001	2011-01-01	MIKE COPELAND
001	2010-01-01	MIKE COPELAND

Plan Statistics for COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN

401k plan membership statisitcs for COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN

Measure Date Value
2016: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 23
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 23
Total of all active and inactive participants 2016-01-01 23
Total participants 2016-01-01 23
Number of participants with account balances 2016-01-01 19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 23
Total of all active and inactive participants 2015-01-01 23
Total participants 2015-01-01 23
Number of participants with account balances 2015-01-01 17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 0
2014: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 28
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 26
Total of all active and inactive participants 2014-01-01 26
Total participants 2014-01-01 26
Number of participants with account balances 2014-01-01 21
2013: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 27
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 28
Total of all active and inactive participants 2013-01-01 28
Total participants 2013-01-01 28
Number of participants with account balances 2013-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 2
2012: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 25
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 27
Total of all active and inactive participants 2012-01-01 27
Total participants 2012-01-01 27
Number of participants with account balances 2012-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 0
2011: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 25
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 25
Number of retired or separated participants receiving benefits 2011-01-01 0
Number of other retired or separated participants entitled to future benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 25
Number of participants with account balances 2011-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 26
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 26
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 0
Total of all active and inactive participants 2010-01-01 26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 26
Number of participants with account balances 2010-01-01 16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 0

Measure	Date	Value
2016: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	23
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	23
Total of all active and inactive participants	2016-01-01	23
Total participants	2016-01-01	23
Number of participants with account balances	2016-01-01	19
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	23
Total of all active and inactive participants	2015-01-01	23
Total participants	2015-01-01	23
Number of participants with account balances	2015-01-01	17
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	26
Total of all active and inactive participants	2014-01-01	26
Total participants	2014-01-01	26
Number of participants with account balances	2014-01-01	21
2013: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	28
Total of all active and inactive participants	2013-01-01	28
Total participants	2013-01-01	28
Number of participants with account balances	2013-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2012: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	25
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	27
Total of all active and inactive participants	2012-01-01	27
Total participants	2012-01-01	27
Number of participants with account balances	2012-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	0
2011: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	25
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	25
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	25
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	25
Number of participants with account balances	2011-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	26
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	0
Total of all active and inactive participants	2010-01-01	26
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	26
Number of participants with account balances	2010-01-01	16
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	0

Financial Data on COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN

Measure	Date	Value
2016 : COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$89,374
Expenses. Total of all expenses incurred	2016-12-31	$13,647
Benefits paid (including direct rollovers)	2016-12-31	$6,039
Total plan assets at end of year	2016-12-31	$904,549
Total plan assets at beginning of year	2016-12-31	$828,822
Value of fidelity bond covering the plan	2016-12-31	$1,000,000
Total contributions received or receivable from participants	2016-12-31	$39,964
Other income received	2016-12-31	$49,410
Net income (gross income less expenses)	2016-12-31	$75,727
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$904,549
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$828,822
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$7,608
2015 : COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$24,443
Expenses. Total of all expenses incurred	2015-12-31	$11,280
Benefits paid (including direct rollovers)	2015-12-31	$6,107
Total plan assets at end of year	2015-12-31	$828,822
Total plan assets at beginning of year	2015-12-31	$815,659
Value of fidelity bond covering the plan	2015-12-31	$500,000
Total contributions received or receivable from participants	2015-12-31	$43,857
Other income received	2015-12-31	$-19,414
Net income (gross income less expenses)	2015-12-31	$13,163
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$828,822
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$815,659
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$5,173
2014 : COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$61,850
Expenses. Total of all expenses incurred	2014-12-31	$6,356
Benefits paid (including direct rollovers)	2014-12-31	$5,666
Total plan assets at end of year	2014-12-31	$815,659
Total plan assets at beginning of year	2014-12-31	$760,165
Value of fidelity bond covering the plan	2014-12-31	$250,000
Total contributions received or receivable from participants	2014-12-31	$34,817
Contributions received from other sources (not participants or employers)	2014-12-31	$255
Other income received	2014-12-31	$26,778
Net income (gross income less expenses)	2014-12-31	$55,494
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$815,659
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$760,165
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$690
2013 : COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$104,586
Expenses. Total of all expenses incurred	2013-12-31	$44,046
Benefits paid (including direct rollovers)	2013-12-31	$44,021
Total plan assets at end of year	2013-12-31	$760,165
Total plan assets at beginning of year	2013-12-31	$699,625
Value of fidelity bond covering the plan	2013-12-31	$250,000
Total contributions received or receivable from participants	2013-12-31	$31,850
Contributions received from other sources (not participants or employers)	2013-12-31	$700
Other income received	2013-12-31	$72,036
Net income (gross income less expenses)	2013-12-31	$60,540
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$760,165
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$699,625
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$25
2012 : COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$125,684
Expenses. Total of all expenses incurred	2012-12-31	$7,121
Benefits paid (including direct rollovers)	2012-12-31	$7,108
Total plan assets at end of year	2012-12-31	$699,625
Total plan assets at beginning of year	2012-12-31	$581,062
Value of fidelity bond covering the plan	2012-12-31	$250,000
Total contributions received or receivable from participants	2012-12-31	$35,624
Contributions received from other sources (not participants or employers)	2012-12-31	$18,435
Other income received	2012-12-31	$71,625
Net income (gross income less expenses)	2012-12-31	$118,563
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$699,625
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$581,062
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$13
2011 : COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$15,840
Expenses. Total of all expenses incurred	2011-12-31	$8,075
Benefits paid (including direct rollovers)	2011-12-31	$8,075
Total plan assets at end of year	2011-12-31	$581,062
Total plan assets at beginning of year	2011-12-31	$573,297
Value of fidelity bond covering the plan	2011-12-31	$250,000
Total contributions received or receivable from participants	2011-12-31	$31,444
Other income received	2011-12-31	$-15,604
Net income (gross income less expenses)	2011-12-31	$7,765
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$581,062
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$573,297
2010 : COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$77,446
Expenses. Total of all expenses incurred	2010-12-31	$31,700
Benefits paid (including direct rollovers)	2010-12-31	$31,170
Total plan assets at end of year	2010-12-31	$573,297
Total plan assets at beginning of year	2010-12-31	$527,551
Value of fidelity bond covering the plan	2010-12-31	$250,000
Total contributions received or receivable from participants	2010-12-31	$15,431
Expenses. Other expenses not covered elsewhere	2010-12-31	$124
Contributions received from other sources (not participants or employers)	2010-12-31	$3,806
Other income received	2010-12-31	$58,209
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$45,746
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$573,297
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$527,551
Total contributions received or receivable from employer(s)	2010-12-31	$0
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$406
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0

Form 5500 Responses for COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN

2016: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

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

Policy contract number

331955-01

Policy instance

Insurance contract or identification number	331955-01
Number of Individuals Covered	6
Insurance policy start date	2016-01-01
Insurance policy end date	2016-12-31
Total amount of commissions paid to insurance broker	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

331955-01

Policy instance

Insurance contract or identification number	331955-01
Number of Individuals Covered	5
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $699
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $699
Insurance broker organization code?	3
Insurance broker name	JAMES IZETT

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

Policy contract number

331955-01

Policy instance

Insurance contract or identification number	331955-01
Number of Individuals Covered	25
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,780
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,703
Insurance broker organization code?	3
Insurance broker name	JAMES IZETT

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

Policy contract number

331955-01

Policy instance

Insurance contract or identification number	331955-01
Number of Individuals Covered	24
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $3,526
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,526
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES IZETT

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

Policy contract number

331955-01

Policy instance

Insurance contract or identification number	331955-01
Number of Individuals Covered	30
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $2,542
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,199
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES IZETT

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

Policy contract number

331955-01

Policy instance

Insurance contract or identification number	331955-01
Number of Individuals Covered	30
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,795
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

610141

Policy instance

Insurance contract or identification number	610141
Number of Individuals Covered	28
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $378
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $378
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	JAMES IZETT, CHFC, CLU

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

Policy contract number

331955-01

Policy instance

Insurance contract or identification number	331955-01
Number of Individuals Covered	25
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $5,250
Total amount of fees paid to insurance company	USD $0
Are there contracts with unallocated funds for contracts of type guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,725
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	DAVID WESTNEDGE

Potentially related plans

COPELANDS EMPLOYEE INCENTIVE SAVINGS PLAN [EIN = 621582752]

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Company Name:	COPELANDS, INC.
Employer identification number (EIN):	620721221
NAIC Classification:	332900