401k Plan data: EMPLOYEE BENEFIT PLAN plan

EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	EMPLOYEE BENEFIT PLAN
Plan identification number	501

EMPLOYEE BENEFIT 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) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

VILLAGE NURSERIES, LP has sponsored the creation of one or more 401k plans.

Company Name: VILLAGE NURSERIES, LP

Employer identification number (EIN): 952997084

NAIC Classification: 111400
NAIC Description: Greenhouse, Nursery, and Floriculture Production

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2016-02-01 RICHARD REHM
501 2015-02-01 CHARLES JOHNSON
501 2014-02-01 WAYNE JOHNSON
501 2013-02-01 WAYNE JOHNSON
501 2012-02-01 WAYNE JOHNSON
501 2011-02-01 WAYNE JOHNSON
501 2009-02-01 WAYNE JOHNSON

Plan id#	Filing Submission Date	Name of Administrator
501	2016-02-01	RICHARD REHM
501	2015-02-01	CHARLES JOHNSON
501	2014-02-01	WAYNE JOHNSON
501	2013-02-01	WAYNE JOHNSON
501	2012-02-01	WAYNE JOHNSON
501	2011-02-01	WAYNE JOHNSON
501	2009-02-01	WAYNE JOHNSON

Plan Statistics for EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for EMPLOYEE BENEFIT PLAN

Measure Date Value
2016: EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-02-01 288
Total number of active participants reported on line 7a of the Form 5500 2016-02-01 399
Number of retired or separated participants receiving benefits 2016-02-01 2
Number of other retired or separated participants entitled to future benefits 2016-02-01 0
Total of all active and inactive participants 2016-02-01 401
2015: EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-02-01 268
Total number of active participants reported on line 7a of the Form 5500 2015-02-01 288
Number of retired or separated participants receiving benefits 2015-02-01 0
Number of other retired or separated participants entitled to future benefits 2015-02-01 0
Total of all active and inactive participants 2015-02-01 288
2014: EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-02-01 264
Total number of active participants reported on line 7a of the Form 5500 2014-02-01 268
Total of all active and inactive participants 2014-02-01 268
Total participants 2014-02-01 0
2013: EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-02-01 180
Total number of active participants reported on line 7a of the Form 5500 2013-02-01 262
Total of all active and inactive participants 2013-02-01 262
Total participants 2013-02-01 0
2012: EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-02-01 166
Total number of active participants reported on line 7a of the Form 5500 2012-02-01 180
Total of all active and inactive participants 2012-02-01 180
Total participants 2012-02-01 0
2011: EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-02-01 153
Total number of active participants reported on line 7a of the Form 5500 2011-02-01 166
Total of all active and inactive participants 2011-02-01 166
Total participants 2011-02-01 166
2009: EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-02-01 173
Total number of active participants reported on line 7a of the Form 5500 2009-02-01 154
Total of all active and inactive participants 2009-02-01 154
Total participants 2009-02-01 154

Measure	Date	Value
2016: EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-02-01	288
Total number of active participants reported on line 7a of the Form 5500	2016-02-01	399
Number of retired or separated participants receiving benefits	2016-02-01	2
Number of other retired or separated participants entitled to future benefits	2016-02-01	0
Total of all active and inactive participants	2016-02-01	401
2015: EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-02-01	268
Total number of active participants reported on line 7a of the Form 5500	2015-02-01	288
Number of retired or separated participants receiving benefits	2015-02-01	0
Number of other retired or separated participants entitled to future benefits	2015-02-01	0
Total of all active and inactive participants	2015-02-01	288
2014: EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-02-01	264
Total number of active participants reported on line 7a of the Form 5500	2014-02-01	268
Total of all active and inactive participants	2014-02-01	268
Total participants	2014-02-01	0
2013: EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-02-01	180
Total number of active participants reported on line 7a of the Form 5500	2013-02-01	262
Total of all active and inactive participants	2013-02-01	262
Total participants	2013-02-01	0
2012: EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-02-01	166
Total number of active participants reported on line 7a of the Form 5500	2012-02-01	180
Total of all active and inactive participants	2012-02-01	180
Total participants	2012-02-01	0
2011: EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-02-01	153
Total number of active participants reported on line 7a of the Form 5500	2011-02-01	166
Total of all active and inactive participants	2011-02-01	166
Total participants	2011-02-01	166
2009: EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-02-01	173
Total number of active participants reported on line 7a of the Form 5500	2009-02-01	154
Total of all active and inactive participants	2009-02-01	154
Total participants	2009-02-01	154

Form 5500 Responses for EMPLOYEE BENEFIT PLAN

2016: EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-02-01	Type of plan entity	Single employer plan
2016-02-01	Submission has been amended	No
2016-02-01	This submission is the final filing	No
2016-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-02-01	Plan is a collectively bargained plan	No
2016-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-02-01	Plan benefit arrangement – Insurance	Yes
2015: EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-02-01	Type of plan entity	Single employer plan
2015-02-01	Submission has been amended	No
2015-02-01	This submission is the final filing	No
2015-02-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-02-01	Plan is a collectively bargained plan	No
2015-02-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-02-01	Plan benefit arrangement – Insurance	Yes
2014: EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-02-01	Type of plan entity	Single employer plan
2014-02-01	Plan funding arrangement – Insurance	Yes
2014-02-01	Plan benefit arrangement – Insurance	Yes
2013: EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-02-01	Type of plan entity	Single employer plan
2013-02-01	Plan funding arrangement – Insurance	Yes
2013-02-01	Plan benefit arrangement – Insurance	Yes
2012: EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-02-01	Type of plan entity	Single employer plan
2012-02-01	Plan funding arrangement – Insurance	Yes
2012-02-01	Plan benefit arrangement – Insurance	Yes
2011: EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-02-01	Type of plan entity	Single employer plan
2011-02-01	Plan funding arrangement – Insurance	Yes
2011-02-01	Plan benefit arrangement – Insurance	Yes
2009: EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-02-01	Type of plan entity	Single employer plan
2009-02-01	Plan funding arrangement – Insurance	Yes
2009-02-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E7803265

Policy instance

Insurance contract or identification number	E7803265
Number of Individuals Covered	288
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Total amount of commissions paid to insurance broker	USD $55,161
Total amount of fees paid to insurance company	USD $11,711
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	VOLUNTARY BENEFITS
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $146,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,161
Amount paid for insurance broker fees	11711
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	VARIOUS - SEE ATTACHED

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

600928

Policy instance

Insurance contract or identification number	600928
Number of Individuals Covered	62
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Total amount of commissions paid to insurance broker	USD $15,693
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $323,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,308
Insurance broker organization code?	3
Insurance broker name	FILICE INSURANCE AGENCY

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

Policy contract number

00454889

Policy instance

Insurance contract or identification number	00454889
Number of Individuals Covered	155
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Total amount of commissions paid to insurance broker	USD $7,065
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	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	Yes
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $104,979
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,970
Insurance broker organization code?	3
Insurance broker name	RON FILICE ENTERPRISES INC.

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

170030

Policy instance

Insurance contract or identification number	170030
Number of Individuals Covered	232
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Total amount of commissions paid to insurance broker	USD $62,555
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $1,284,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $41,276
Insurance broker organization code?	3
Insurance broker name	FILICE INSURANCE AGENCY

SAFEGUARD HEALTH PLANS, INC. A CALIFORNIA CORPORATION (National Association of Insurance Commissioners NAIC id number: 96030 )

Policy contract number

KM05753750

Policy instance

Insurance contract or identification number	KM05753750
Number of Individuals Covered	75
Insurance policy start date	2015-02-01
Insurance policy end date	2016-01-31
Total amount of commissions paid to insurance broker	USD $710
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	Yes
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
Welfare Benefit Premiums Paid to Carrier	USD $7,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $470
Insurance broker organization code?	3
Insurance broker name	RON FILICE ENTERPRISES INC.

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

7803265

Policy instance

Insurance contract or identification number	7803265
Number of Individuals Covered	91
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $12,041
Total amount of fees paid to insurance company	USD $1,788
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $64,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,624
Amount paid for insurance broker fees	1245
Insurance broker organization code?	3
Insurance broker name	ELTHON ISRAEL CRUZ

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

Policy contract number

00454889

Policy instance

Insurance contract or identification number	00454889
Number of Individuals Covered	147
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $6,761
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $102,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,761
Insurance broker organization code?	3
Insurance broker name	FINANCIAL BENEFITS SOLUTIONS INC.

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

600928

Policy instance

Insurance contract or identification number	600928
Number of Individuals Covered	54
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $10,629
Welfare Benefit Premiums Paid to Carrier	USD $272,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,629
Insurance broker name	CENTENNIAL GROUP BENIFITS & INS.

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

170030

Policy instance

Insurance contract or identification number	170030
Number of Individuals Covered	214
Insurance policy start date	2014-02-01
Insurance policy end date	2015-01-31
Total amount of commissions paid to insurance broker	USD $42,728
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,042,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $42,728
Insurance broker name	CENTENNIAL GROUP BENIFITS & INS.

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

600928 & 170030

Policy instance

Insurance contract or identification number	600928 & 170030
Number of Individuals Covered	264
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $45,461
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,222,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $45,461
Insurance broker organization code?	3
Insurance broker name	BENEFIT SOLUTIONS COMPANY

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

7803265

Policy instance

Insurance contract or identification number	7803265
Number of Individuals Covered	111
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $6,077
Total amount of fees paid to insurance company	USD $385
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $43,039
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,946
Amount paid for insurance broker fees	278
Insurance broker organization code?	3
Insurance broker name	ELTHON ISRAEL CRUZ

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

Policy contract number

00454889

Policy instance

Insurance contract or identification number	00454889
Number of Individuals Covered	134
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $5,116
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $81,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,116
Insurance broker organization code?	3
Insurance broker name	FINANCIAL BENEFITS SOLUTIONS INC.

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

Policy contract number

00454889

Policy instance

Insurance contract or identification number	00454889
Number of Individuals Covered	108
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $4,744
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $68,793
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,744
Insurance broker organization code?	3
Insurance broker name	FINANCIAL BENEFITS SOLUTIONS INC.

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

600928 & 170030

Policy instance

Insurance contract or identification number	600928 & 170030
Number of Individuals Covered	256
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $40,430
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,001,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,430
Insurance broker organization code?	3
Insurance broker name	BENEFIT SOLUTIONS COMPANY

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

7803265

Policy instance

Insurance contract or identification number	7803265
Number of Individuals Covered	74
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $7,248
Total amount of fees paid to insurance company	USD $579
Life Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,141
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
Insurance broker organization code?	3
Amount paid for insurance broker fees	1
Insurance broker name	SUSIE ANN ESTRADA

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

Policy contract number

00454889

Policy instance

Insurance contract or identification number	00454889
Number of Individuals Covered	105
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $4,424
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

7803265

Policy instance

Insurance contract or identification number	7803265
Number of Individuals Covered	67
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $7,606
Total amount of fees paid to insurance company	USD $319
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,592
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

600928

Policy instance

Insurance contract or identification number	600928
Number of Individuals Covered	159
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $34,353
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $957,226
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

00454889

Policy instance

Insurance contract or identification number	00454889
Number of Individuals Covered	99
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $4,336
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,336
Insurance broker organization code?	3
Insurance broker name	FINANCIAL BENEFITS SOLUTIONS INC.

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

7803265

Policy instance

Insurance contract or identification number	7803265
Number of Individuals Covered	20
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $6,114
Total amount of fees paid to insurance company	USD $207
Life Insurance Welfare Benefit	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 $6,114
Amount paid for insurance broker fees	207
Insurance broker organization code?	3
Insurance broker name	COLONIAL LIFE & ACCIDENT INSURANCE

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )

Policy contract number

600928

Policy instance

Insurance contract or identification number	600928
Number of Individuals Covered	153
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $34,440
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $934,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $34,440
Insurance broker organization code?	3
Insurance broker name	BENEFIT SOLUTIONS COMPANY

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Company Name:	VILLAGE NURSERIES, LP
Employer identification number (EIN):	952997084
NAIC Classification:	111400
NAIC Description:	Greenhouse, Nursery, and Floriculture Production