401k Plan data: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST plan

CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 401k Plan overview

Plan Name	CHATTANOOGA LABELING RETIREMENT PLAN & TRUST
Plan identification number	001

CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 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

CHATTANOOGA LABELING SYSTEMS, INC. has sponsored the creation of one or more 401k plans.

Company Name: CHATTANOOGA LABELING SYSTEMS, INC.

Employer identification number (EIN): 621468836

NAIC Classification: 339900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHATTANOOGA LABELING RETIREMENT PLAN & TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 LORI IVY 2023-05-09 LORI IVY 2023-05-09
001 2021-01-01 MARVIN SMITH 2022-05-31 MARVIN SMITH 2022-05-31
001 2020-01-01 MARVIN SMITH 2021-07-08 MARVIN SMITH 2021-07-08
001 2019-01-01 MARVIN SMITH 2020-05-14 MARVIN SMITH 2020-05-14
001 2018-01-01 MARVIN SMITH 2019-05-21 MARVIN SMITH 2019-05-21
001 2017-01-01 MARVIN SMITH 2018-10-03 MARVIN SMITH 2018-10-03
001 2016-01-01 MARVIN SMITH
001 2015-01-01 MARVIN SMITH
001 2014-01-01 MARVIN SMITH
001 2013-01-01 MARVIN SMITH
001 2012-01-01 MARVIN SMITH
001 2011-01-01 MARVIN SMITH
001 2009-01-01 MARVIN SMITH
001 2009-01-01 MARVIN SMITH

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	LORI IVY	2023-05-09	LORI IVY	2023-05-09
001	2021-01-01	MARVIN SMITH	2022-05-31	MARVIN SMITH	2022-05-31
001	2020-01-01	MARVIN SMITH	2021-07-08	MARVIN SMITH	2021-07-08
001	2019-01-01	MARVIN SMITH	2020-05-14	MARVIN SMITH	2020-05-14
001	2018-01-01	MARVIN SMITH	2019-05-21	MARVIN SMITH	2019-05-21
001	2017-01-01	MARVIN SMITH	2018-10-03	MARVIN SMITH	2018-10-03
001	2016-01-01	MARVIN SMITH
001	2015-01-01	MARVIN SMITH
001	2014-01-01	MARVIN SMITH
001	2013-01-01	MARVIN SMITH
001	2012-01-01	MARVIN SMITH
001	2011-01-01	MARVIN SMITH
001	2009-01-01	MARVIN SMITH
001	2009-01-01	MARVIN SMITH

Plan Statistics for CHATTANOOGA LABELING RETIREMENT PLAN & TRUST

401k plan membership statisitcs for CHATTANOOGA LABELING RETIREMENT PLAN & TRUST

Measure Date Value
2016: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2016 401k membership
Total participants, beginning-of-year 2016-01-01 33
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 29
Total of all active and inactive participants 2016-01-01 29
Total participants 2016-01-01 29
Number of participants with account balances 2016-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year 2015-01-01 41
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 33
Total of all active and inactive participants 2015-01-01 33
Total participants 2015-01-01 33
Number of participants with account balances 2015-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 1
2014: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 40
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 41
Total of all active and inactive participants 2014-01-01 41
Total participants 2014-01-01 41
Number of participants with account balances 2014-01-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 3
2013: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 40
Total of all active and inactive participants 2013-01-01 40
Total participants 2013-01-01 40
Number of participants with account balances 2013-01-01 26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 8
2012: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 44
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 39
Total of all active and inactive participants 2012-01-01 39
Total participants 2012-01-01 39
Number of participants with account balances 2012-01-01 22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 7
2011: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 44
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 41
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 41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 41
Number of participants with account balances 2011-01-01 25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 5
2009: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 37
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 40
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 0
Total of all active and inactive participants 2009-01-01 40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 40
Number of participants with account balances 2009-01-01 21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2016: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2016 401k membership
Total participants, beginning-of-year	2016-01-01	33
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	29
Total of all active and inactive participants	2016-01-01	29
Total participants	2016-01-01	29
Number of participants with account balances	2016-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	41
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	33
Total of all active and inactive participants	2015-01-01	33
Total participants	2015-01-01	33
Number of participants with account balances	2015-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	1
2014: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	40
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	41
Total of all active and inactive participants	2014-01-01	41
Total participants	2014-01-01	41
Number of participants with account balances	2014-01-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	3
2013: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	40
Total of all active and inactive participants	2013-01-01	40
Total participants	2013-01-01	40
Number of participants with account balances	2013-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	8
2012: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	44
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	39
Total of all active and inactive participants	2012-01-01	39
Total participants	2012-01-01	39
Number of participants with account balances	2012-01-01	22
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	7
2011: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	44
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	41
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	41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	41
Number of participants with account balances	2011-01-01	25
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	5
2009: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	37
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	40
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	0
Total of all active and inactive participants	2009-01-01	40
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	40
Number of participants with account balances	2009-01-01	21
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on CHATTANOOGA LABELING RETIREMENT PLAN & TRUST

Measure	Date	Value
2016 : CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2016 401k financial data
Total income from all sources	2016-12-31	$212,876
Expenses. Total of all expenses incurred	2016-12-31	$101,934
Benefits paid (including direct rollovers)	2016-12-31	$87,846
Total plan assets at end of year	2016-12-31	$818,521
Total plan assets at beginning of year	2016-12-31	$707,579
Value of fidelity bond covering the plan	2016-12-31	$80,000
Total contributions received or receivable from participants	2016-12-31	$120,083
Contributions received from other sources (not participants or employers)	2016-12-31	$-51
Other income received	2016-12-31	$65,645
Net income (gross income less expenses)	2016-12-31	$110,942
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$818,521
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$707,579
Total contributions received or receivable from employer(s)	2016-12-31	$27,199
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$14,088
2015 : CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2015 401k financial data
Total income from all sources	2015-12-31	$42,335
Expenses. Total of all expenses incurred	2015-12-31	$62,302
Benefits paid (including direct rollovers)	2015-12-31	$60,474
Total plan assets at end of year	2015-12-31	$707,579
Total plan assets at beginning of year	2015-12-31	$727,546
Value of fidelity bond covering the plan	2015-12-31	$70,000
Total contributions received or receivable from participants	2015-12-31	$47,107
Contributions received from other sources (not participants or employers)	2015-12-31	$1,353
Other income received	2015-12-31	$-20,588
Net income (gross income less expenses)	2015-12-31	$-19,967
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$707,579
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$727,546
Total contributions received or receivable from employer(s)	2015-12-31	$14,463
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$1,828
2014 : CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2014 401k financial data
Total income from all sources	2014-12-31	$107,412
Expenses. Total of all expenses incurred	2014-12-31	$25,514
Benefits paid (including direct rollovers)	2014-12-31	$23,519
Total plan assets at end of year	2014-12-31	$727,546
Total plan assets at beginning of year	2014-12-31	$645,648
Value of fidelity bond covering the plan	2014-12-31	$70,000
Total contributions received or receivable from participants	2014-12-31	$62,840
Contributions received from other sources (not participants or employers)	2014-12-31	$1,430
Other income received	2014-12-31	$22,502
Net income (gross income less expenses)	2014-12-31	$81,898
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$727,546
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$645,648
Total contributions received or receivable from employer(s)	2014-12-31	$20,640
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$1,995
2013 : CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2013 401k financial data
Total income from all sources	2013-12-31	$133,411
Expenses. Total of all expenses incurred	2013-12-31	$4,944
Benefits paid (including direct rollovers)	2013-12-31	$2,890
Total plan assets at end of year	2013-12-31	$645,648
Total plan assets at beginning of year	2013-12-31	$517,181
Value of fidelity bond covering the plan	2013-12-31	$70,000
Total contributions received or receivable from participants	2013-12-31	$36,694
Contributions received from other sources (not participants or employers)	2013-12-31	$1,058
Other income received	2013-12-31	$80,320
Net income (gross income less expenses)	2013-12-31	$128,467
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$645,648
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$517,181
Total contributions received or receivable from employer(s)	2013-12-31	$15,339
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$2,054
2012 : CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2012 401k financial data
Total income from all sources	2012-12-31	$103,876
Expenses. Total of all expenses incurred	2012-12-31	$37,759
Benefits paid (including direct rollovers)	2012-12-31	$37,016
Total plan assets at end of year	2012-12-31	$517,181
Total plan assets at beginning of year	2012-12-31	$451,064
Value of fidelity bond covering the plan	2012-12-31	$50,000
Total contributions received or receivable from participants	2012-12-31	$33,331
Contributions received from other sources (not participants or employers)	2012-12-31	$104
Other income received	2012-12-31	$57,187
Net income (gross income less expenses)	2012-12-31	$66,117
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$517,181
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$451,064
Total contributions received or receivable from employer(s)	2012-12-31	$13,254
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$743
2011 : CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2011 401k financial data
Total income from all sources	2011-12-31	$27,024
Expenses. Total of all expenses incurred	2011-12-31	$49,602
Benefits paid (including direct rollovers)	2011-12-31	$48,920
Total plan assets at end of year	2011-12-31	$451,064
Total plan assets at beginning of year	2011-12-31	$473,642
Value of fidelity bond covering the plan	2011-12-31	$50,000
Total contributions received or receivable from participants	2011-12-31	$34,708
Contributions received from other sources (not participants or employers)	2011-12-31	$347
Other income received	2011-12-31	$-22,041
Net income (gross income less expenses)	2011-12-31	$-22,578
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$451,064
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$473,642
Total contributions received or receivable from employer(s)	2011-12-31	$14,010
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$682
2010 : CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2010 401k financial data
Total income from all sources	2010-12-31	$115,750
Expenses. Total of all expenses incurred	2010-12-31	$33,540
Benefits paid (including direct rollovers)	2010-12-31	$24,690
Total plan assets at end of year	2010-12-31	$473,642
Total plan assets at beginning of year	2010-12-31	$391,432
Value of fidelity bond covering the plan	2010-12-31	$50,000
Total contributions received or receivable from participants	2010-12-31	$46,671
Expenses. Other expenses not covered elsewhere	2010-12-31	$611
Contributions received from other sources (not participants or employers)	2010-12-31	$8,610
Other income received	2010-12-31	$46,210
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$82,210
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$473,642
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$391,432
Total contributions received or receivable from employer(s)	2010-12-31	$14,259
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	$8,239
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 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 CHATTANOOGA LABELING RETIREMENT PLAN & TRUST

2016: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 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: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 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: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 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: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 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: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 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: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 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
2009: CHATTANOOGA LABELING RETIREMENT PLAN & TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	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

331957-01

Policy instance

Insurance contract or identification number	331957-01
Number of Individuals Covered	3
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

331957-01

Policy instance

Insurance contract or identification number	331957-01
Number of Individuals Covered	4
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $235
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 $235
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

331957-01

Policy instance

Insurance contract or identification number	331957-01
Number of Individuals Covered	35
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,228
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 $2,305
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

331957-01

Policy instance

Insurance contract or identification number	331957-01
Number of Individuals Covered	33
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,714
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 $2,714
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

331957-01

Policy instance

Insurance contract or identification number	331957-01
Number of Individuals Covered	36
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $1,991
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 $874
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

331957-01

Policy instance

Insurance contract or identification number	331957-01
Number of Individuals Covered	37
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $2,613
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

612198

Policy instance

Insurance contract or identification number	612198
Number of Individuals Covered	46
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $577
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 $328
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	TRACEY L. HAY

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

Policy contract number

331957-01

Policy instance

Insurance contract or identification number	331957-01
Number of Individuals Covered	39
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,316
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 $3,884
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	DAVID WESTNEDGE

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Company Name:	CHATTANOOGA LABELING SYSTEMS, INC.
Employer identification number (EIN):	621468836
NAIC Classification:	339900