401k Plan data: CONTACT INDUSTRIES HEALTH & WELFARE PLAN plan

CONTACT INDUSTRIES HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	CONTACT INDUSTRIES HEALTH & WELFARE PLAN
Plan identification number	501

CONTACT INDUSTRIES HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Other welfare benefit cover

401k Sponsoring company profile

CONTACT INDUSTRIES has sponsored the creation of one or more 401k plans.

Company Name: CONTACT INDUSTRIES

Employer identification number (EIN): 930339409

NAIC Classification: 321900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CONTACT INDUSTRIES HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-01-01 FRANK PEARSON
501 2015-01-01 FRANK PEARSON
501 2013-01-01 FRANK PEARSON
501 2012-01-01 FRANK PEARSON
501 2011-01-01 FRANK PEARSON
501 2009-01-01 FRANK PEARSON

Plan id#	Filing Submission Date	Name of Administrator
501	2016-01-01	FRANK PEARSON
501	2015-01-01	FRANK PEARSON
501	2013-01-01	FRANK PEARSON
501	2012-01-01	FRANK PEARSON
501	2011-01-01	FRANK PEARSON
501	2009-01-01	FRANK PEARSON

Plan Statistics for CONTACT INDUSTRIES HEALTH & WELFARE PLAN

401k plan membership statisitcs for CONTACT INDUSTRIES HEALTH & WELFARE PLAN

Measure Date Value
2016: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 216
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 210
Total of all active and inactive participants 2016-01-01 210
2015: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 191
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 208
Total of all active and inactive participants 2015-01-01 208
2013: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 168
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 180
Total of all active and inactive participants 2013-01-01 180
Total participants 2013-01-01 0
2012: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 192
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 166
Total of all active and inactive participants 2012-01-01 166
Total participants 2012-01-01 0
2011: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 231
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 192
Total of all active and inactive participants 2011-01-01 192
Total participants 2011-01-01 192
2009: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 363
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 246
Total of all active and inactive participants 2009-01-01 246
Total participants 2009-01-01 246

Measure	Date	Value
2016: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	216
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	210
Total of all active and inactive participants	2016-01-01	210
2015: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	191
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	208
Total of all active and inactive participants	2015-01-01	208
2013: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	168
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	180
Total of all active and inactive participants	2013-01-01	180
Total participants	2013-01-01	0
2012: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	192
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	166
Total of all active and inactive participants	2012-01-01	166
Total participants	2012-01-01	0
2011: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	231
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	192
Total of all active and inactive participants	2011-01-01	192
Total participants	2011-01-01	192
2009: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	363
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	246
Total of all active and inactive participants	2009-01-01	246
Total participants	2009-01-01	246

Financial Data on CONTACT INDUSTRIES HEALTH & WELFARE PLAN

Measure	Date	Value
2010 : CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2010 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Was this plan covered by a fidelity bond	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
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
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
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
Did the plan have assets held for investment	2010-12-31	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	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

Form 5500 Responses for CONTACT INDUSTRIES HEALTH & WELFARE PLAN

2016: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	This submission is the final filing	Yes
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: CONTACT INDUSTRIES HEALTH & WELFARE 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 – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: CONTACT INDUSTRIES HEALTH & WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: CONTACT INDUSTRIES HEALTH & WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2011: CONTACT INDUSTRIES HEALTH & WELFARE 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 funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: CONTACT INDUSTRIES HEALTH & WELFARE PLAN 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 funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

0007504655

Policy instance

Insurance contract or identification number	0007504655
Number of Individuals Covered	64
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $807
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $16,336
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $557
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 79065 )

Policy contract number

Policy instance

Number of Individuals Covered	388
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
Welfare Benefit Premiums Paid to Carrier	USD $183,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

03104012

Policy instance

Insurance contract or identification number	03104012
Number of Individuals Covered	236
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
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

125319

Policy instance

Insurance contract or identification number	125319
Number of Individuals Covered	514
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $64
Total amount of fees paid to insurance company	USD $2
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $64
Amount paid for insurance broker fees	2
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

535167

Policy instance

Insurance contract or identification number	535167
Number of Individuals Covered	49
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,818
Total amount of fees paid to insurance company	USD $141
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,818
Amount paid for insurance broker fees	141
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

094906

Policy instance

Insurance contract or identification number	094906
Number of Individuals Covered	224
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
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,459
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

R0021303

Policy instance

Insurance contract or identification number	R0021303
Number of Individuals Covered	52
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
Other welfare benefits provided	GCIEE, GRPACCVO
Welfare Benefit Premiums Paid to Carrier	USD $5,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

03104012

Policy instance

Insurance contract or identification number	03104012
Number of Individuals Covered	211
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,125
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

094906

Policy instance

Insurance contract or identification number	094906
Number of Individuals Covered	190
Total amount of fees paid to insurance company	USD $187
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $22,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	187
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

535167

Policy instance

Insurance contract or identification number	535167
Number of Individuals Covered	39
Total amount of commissions paid to insurance broker	USD $3,009
Total amount of fees paid to insurance company	USD $150
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $18,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,009
Amount paid for insurance broker fees	150
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

7504655

Policy instance

Insurance contract or identification number	7504655
Number of Individuals Covered	78
Total amount of commissions paid to insurance broker	USD $1,026
Other welfare benefits provided	ACCIDENT,CRITICAL ILL,ISTD PROTECT
Welfare Benefit Premiums Paid to Carrier	USD $20,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $696
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

PF003380-01

Policy instance

Insurance contract or identification number	PF003380-01
Number of Individuals Covered	350
Welfare Benefit Premiums Paid to Carrier	USD $184,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

7504655

Policy instance

Insurance contract or identification number	7504655
Number of Individuals Covered	105
Total amount of commissions paid to insurance broker	USD $1,359
Other welfare benefits provided	ACCIDENT,CRITICAL ILL,ISTD PROTECT
Welfare Benefit Premiums Paid to Carrier	USD $23,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $484
Insurance broker organization code?	3
Insurance broker name	JAMES V. HUNT, SR.

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

Policy contract number

16-010101-000

Policy instance

Insurance contract or identification number	16-010101-000
Number of Individuals Covered	175
Total amount of fees paid to insurance company	USD $9,735
Welfare Benefit Premiums Paid to Carrier	USD $196,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	9735
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

03104012

Policy instance

Insurance contract or identification number	03104012
Number of Individuals Covered	170
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $7,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

094906

Policy instance

Insurance contract or identification number	094906
Number of Individuals Covered	178
Total amount of fees paid to insurance company	USD $163
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	163
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

535167

Policy instance

Insurance contract or identification number	535167
Number of Individuals Covered	41
Total amount of commissions paid to insurance broker	USD $2,236
Total amount of fees paid to insurance company	USD $112
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,236
Amount paid for insurance broker fees	112
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

125319

Policy instance

Insurance contract or identification number	125319
Number of Individuals Covered	7
Total amount of commissions paid to insurance broker	USD $516
Total amount of fees paid to insurance company	USD $17
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $2,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $516
Amount paid for insurance broker fees	17
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

125319

Policy instance

Insurance contract or identification number	125319
Number of Individuals Covered	48
Total amount of commissions paid to insurance broker	USD $3,237
Total amount of fees paid to insurance company	USD $121
Other welfare benefits provided	LONG TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $16,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

BTA-22961

Policy instance

Insurance contract or identification number	BTA-22961
Number of Individuals Covered	5
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

535167

Policy instance

Insurance contract or identification number	535167
Number of Individuals Covered	34
Total amount of commissions paid to insurance broker	USD $1,749
Total amount of fees paid to insurance company	USD $87
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

094906

Policy instance

Insurance contract or identification number	094906
Number of Individuals Covered	188
Total amount of fees paid to insurance company	USD $603
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

03104012

Policy instance

Insurance contract or identification number	03104012
Number of Individuals Covered	203
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

7504655

Policy instance

Insurance contract or identification number	7504655
Number of Individuals Covered	111
Total amount of commissions paid to insurance broker	USD $1,591
Other welfare benefits provided	ACCIDENT,CRITICAL ILL,ISTD PROTECT
Welfare Benefit Premiums Paid to Carrier	USD $31,610
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

16-010101-000

Policy instance

Insurance contract or identification number	16-010101-000
Number of Individuals Covered	192
Total amount of fees paid to insurance company	USD $1,910
Welfare Benefit Premiums Paid to Carrier	USD $210,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

03104012

Policy instance

Insurance contract or identification number	03104012
Number of Individuals Covered	230
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

16-010101-000

Policy instance

Insurance contract or identification number	16-010101-000
Number of Individuals Covered	224
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Welfare Benefit Premiums Paid to Carrier	USD $160,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

029381

Policy instance

Insurance contract or identification number	029381
Number of Individuals Covered	43
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 )

Policy contract number

BTA-22961

Policy instance

Insurance contract or identification number	BTA-22961
Number of Individuals Covered	5
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $150
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $150
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

000000535167

Policy instance

Insurance contract or identification number	000000535167
Number of Individuals Covered	34
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $1,749
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $11,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,749
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

125319

Policy instance

Insurance contract or identification number	125319
Number of Individuals Covered	48
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $3,237
Other welfare benefits provided	GROUP LONG-TERM CARE
Welfare Benefit Premiums Paid to Carrier	USD $16,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,237
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )

Policy contract number

7504655

Policy instance

Insurance contract or identification number	7504655
Number of Individuals Covered	452
Insurance policy start date	2010-01-01
Insurance policy end date	2011-01-01
Total amount of commissions paid to insurance broker	USD $1,859
Other welfare benefits provided	ACCIDENT,CRITICAL ILL,ISTD PROTECT
Welfare Benefit Premiums Paid to Carrier	USD $36,346
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $560
Insurance broker organization code?	3
Insurance broker name	JAMES V. HUNT, SR.

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

029381

Policy instance

Insurance contract or identification number	029381
Number of Individuals Covered	336
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	DAVIDSON BENEFITS PLANNING LLC

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Company Name:	CONTACT INDUSTRIES
Employer identification number (EIN):	930339409
NAIC Classification:	321900