401k Plan data: LEATHER CREATIONS 401(K) RETIREMENT PLAN plan

LEATHER CREATIONS 401(K) RETIREMENT PLAN 401k Plan overview

Plan Name	LEATHER CREATIONS 401(K) RETIREMENT PLAN
Plan identification number	001

LEATHER CREATIONS 401(K) RETIREMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing
ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
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.
Prototype plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion or notification letter; and under which a seperate funding medium (for example, a seperate trust or custodial account) is established for the use of each adopting employer.
Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).

401k Sponsoring company profile

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

Company Name: LEATHER CREATIONS, INC.

Employer identification number (EIN): 954463130

NAIC Classification: 442110
NAIC Description: Furniture Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEATHER CREATIONS 401(K) RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01 TOMMY HORST 2024-02-13
001 2022-01-01 TOMMY HORST 2023-05-01
001 2021-01-01 TOMMY HORST 2022-05-26
001 2020-01-01
001 2019-01-01 DONNA COOKE 2020-03-06
001 2018-01-01 ROGER MILLER 2019-05-06 ROGER MILLER 2019-05-06
001 2017-01-01 ROGER MILLER 2018-06-28 ROGER MILLER 2018-06-28
001 2016-01-01 ROGER MILLER
001 2015-01-01 ROGER MILLER
001 2014-01-01 ROGER MILLER
001 2013-01-01 ROGER MILLER
001 2012-01-01 ROGER MILLER
001 2011-01-01 ROGER MILLER SCOTT LOBEL 2012-07-03
001 2009-01-01 ROGER MILLER SCOTT LOBEL 2010-06-25
001 2009-01-01 ROGER MILLER SCOTT LOBEL 2010-07-14

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2023-01-01	TOMMY HORST	2024-02-13
001	2022-01-01	TOMMY HORST	2023-05-01
001	2021-01-01	TOMMY HORST	2022-05-26
001	2020-01-01
001	2019-01-01	DONNA COOKE	2020-03-06
001	2018-01-01	ROGER MILLER	2019-05-06	ROGER MILLER	2019-05-06
001	2017-01-01	ROGER MILLER	2018-06-28	ROGER MILLER	2018-06-28
001	2016-01-01	ROGER MILLER
001	2015-01-01	ROGER MILLER
001	2014-01-01	ROGER MILLER
001	2013-01-01	ROGER MILLER
001	2012-01-01	ROGER MILLER
001	2011-01-01	ROGER MILLER		SCOTT LOBEL	2012-07-03
001	2009-01-01	ROGER MILLER		SCOTT LOBEL	2010-06-25
001	2009-01-01	ROGER MILLER		SCOTT LOBEL	2010-07-14

Plan Statistics for LEATHER CREATIONS 401(K) RETIREMENT PLAN

401k plan membership statisitcs for LEATHER CREATIONS 401(K) RETIREMENT PLAN

Measure Date Value
2016: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 44
Total of all active and inactive participants 2016-01-01 44
Total participants 2016-01-01 44
Number of participants with account balances 2016-01-01 33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-01-01 0
2015: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 39
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 39
Total of all active and inactive participants 2015-01-01 39
Total participants 2015-01-01 39
Number of participants with account balances 2015-01-01 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-01-01 2
2014: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 36
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 39
Total of all active and inactive participants 2014-01-01 39
Total participants 2014-01-01 39
Number of participants with account balances 2014-01-01 30
2013: LEATHER CREATIONS 401(K) RETIREMENT PLAN 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 36
Total of all active and inactive participants 2013-01-01 36
Total participants 2013-01-01 36
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: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 43
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 30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 6
2011: LEATHER CREATIONS 401(K) RETIREMENT PLAN 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 42
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 42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-01-01 0
Total participants 2011-01-01 42
Number of participants with account balances 2011-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 5
2009: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 64
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 58
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 58
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 58
Number of participants with account balances 2009-01-01 40
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 1

Measure	Date	Value
2016: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	44
Total of all active and inactive participants	2016-01-01	44
Total participants	2016-01-01	44
Number of participants with account balances	2016-01-01	33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	0
2015: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	39
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	39
Total of all active and inactive participants	2015-01-01	39
Total participants	2015-01-01	39
Number of participants with account balances	2015-01-01	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	2
2014: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	36
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	39
Total of all active and inactive participants	2014-01-01	39
Total participants	2014-01-01	39
Number of participants with account balances	2014-01-01	30
2013: LEATHER CREATIONS 401(K) RETIREMENT PLAN 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	36
Total of all active and inactive participants	2013-01-01	36
Total participants	2013-01-01	36
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: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	43
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	30
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	6
2011: LEATHER CREATIONS 401(K) RETIREMENT PLAN 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	42
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	42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-01-01	0
Total participants	2011-01-01	42
Number of participants with account balances	2011-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	5
2009: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	64
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	58
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	58
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	58
Number of participants with account balances	2009-01-01	40
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on LEATHER CREATIONS 401(K) RETIREMENT PLAN

Measure	Date	Value
2016 : LEATHER CREATIONS 401(K) RETIREMENT PLAN 2016 401k financial data
Total income from all sources	2016-12-31	$296,486
Expenses. Total of all expenses incurred	2016-12-31	$182,077
Benefits paid (including direct rollovers)	2016-12-31	$152,423
Total plan assets at end of year	2016-12-31	$2,064,283
Total plan assets at beginning of year	2016-12-31	$1,949,874
Value of fidelity bond covering the plan	2016-12-31	$200,000
Total contributions received or receivable from participants	2016-12-31	$112,332
Contributions received from other sources (not participants or employers)	2016-12-31	$-617
Other income received	2016-12-31	$149,114
Net income (gross income less expenses)	2016-12-31	$114,409
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$2,064,283
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$1,949,874
Assets. Value of participant loans	2016-12-31	$133,435
Total contributions received or receivable from employer(s)	2016-12-31	$35,657
Value of certain deemed distributions of participant loans	2016-12-31	$5,937
Value of corrective distributions	2016-12-31	$53
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$23,664
2015 : LEATHER CREATIONS 401(K) RETIREMENT PLAN 2015 401k financial data
Total income from all sources	2015-12-31	$112,158
Expenses. Total of all expenses incurred	2015-12-31	$70,398
Benefits paid (including direct rollovers)	2015-12-31	$53,066
Total plan assets at end of year	2015-12-31	$1,949,874
Total plan assets at beginning of year	2015-12-31	$1,908,114
Value of fidelity bond covering the plan	2015-12-31	$200,000
Total contributions received or receivable from participants	2015-12-31	$100,941
Contributions received from other sources (not participants or employers)	2015-12-31	$11,924
Other income received	2015-12-31	$-30,942
Net income (gross income less expenses)	2015-12-31	$41,760
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$1,949,874
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,908,114
Assets. Value of participant loans	2015-12-31	$143,614
Total contributions received or receivable from employer(s)	2015-12-31	$30,235
Value of certain deemed distributions of participant loans	2015-12-31	$16,094
Value of corrective distributions	2015-12-31	$450
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$788
2014 : LEATHER CREATIONS 401(K) RETIREMENT PLAN 2014 401k financial data
Total income from all sources	2014-12-31	$202,951
Expenses. Total of all expenses incurred	2014-12-31	$37,286
Benefits paid (including direct rollovers)	2014-12-31	$35,201
Total plan assets at end of year	2014-12-31	$1,908,114
Total plan assets at beginning of year	2014-12-31	$1,742,449
Value of fidelity bond covering the plan	2014-12-31	$200,000
Total contributions received or receivable from participants	2014-12-31	$98,346
Contributions received from other sources (not participants or employers)	2014-12-31	$1,294
Other income received	2014-12-31	$75,250
Net income (gross income less expenses)	2014-12-31	$165,665
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,908,114
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,742,449
Assets. Value of participant loans	2014-12-31	$154,812
Total contributions received or receivable from employer(s)	2014-12-31	$28,061
Value of corrective distributions	2014-12-31	$1,310
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$775
2013 : LEATHER CREATIONS 401(K) RETIREMENT PLAN 2013 401k financial data
Total income from all sources	2013-12-31	$299,171
Expenses. Total of all expenses incurred	2013-12-31	$167,733
Benefits paid (including direct rollovers)	2013-12-31	$152,530
Total plan assets at end of year	2013-12-31	$1,742,449
Total plan assets at beginning of year	2013-12-31	$1,611,011
Value of fidelity bond covering the plan	2013-12-31	$200,000
Total contributions received or receivable from participants	2013-12-31	$70,066
Contributions received from other sources (not participants or employers)	2013-12-31	$4,100
Other income received	2013-12-31	$203,565
Net income (gross income less expenses)	2013-12-31	$131,438
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,742,449
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,611,011
Assets. Value of participant loans	2013-12-31	$141,953
Total contributions received or receivable from employer(s)	2013-12-31	$21,440
Value of certain deemed distributions of participant loans	2013-12-31	$12,534
Value of corrective distributions	2013-12-31	$1,756
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$913
2012 : LEATHER CREATIONS 401(K) RETIREMENT PLAN 2012 401k financial data
Total income from all sources	2012-12-31	$257,720
Expenses. Total of all expenses incurred	2012-12-31	$132,426
Benefits paid (including direct rollovers)	2012-12-31	$99,133
Total plan assets at end of year	2012-12-31	$1,611,011
Total plan assets at beginning of year	2012-12-31	$1,485,717
Value of fidelity bond covering the plan	2012-12-31	$200,000
Total contributions received or receivable from participants	2012-12-31	$86,194
Contributions received from other sources (not participants or employers)	2012-12-31	$2,112
Other income received	2012-12-31	$143,988
Net income (gross income less expenses)	2012-12-31	$125,294
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$1,611,011
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$1,485,717
Assets. Value of participant loans	2012-12-31	$116,571
Total contributions received or receivable from employer(s)	2012-12-31	$25,426
Value of certain deemed distributions of participant loans	2012-12-31	$32,180
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$1,113
2011 : LEATHER CREATIONS 401(K) RETIREMENT PLAN 2011 401k financial data
Total income from all sources	2011-12-31	$155,302
Expenses. Total of all expenses incurred	2011-12-31	$266,249
Benefits paid (including direct rollovers)	2011-12-31	$237,081
Total plan assets at end of year	2011-12-31	$1,485,717
Total plan assets at beginning of year	2011-12-31	$1,596,664
Value of fidelity bond covering the plan	2011-12-31	$200,000
Total contributions received or receivable from participants	2011-12-31	$152,901
Contributions received from other sources (not participants or employers)	2011-12-31	$3,024
Other income received	2011-12-31	$-47,075
Net income (gross income less expenses)	2011-12-31	$-110,947
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,485,717
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$1,596,664
Assets. Value of participant loans	2011-12-31	$201,547
Total contributions received or receivable from employer(s)	2011-12-31	$46,452
Value of certain deemed distributions of participant loans	2011-12-31	$27,855
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$1,313
2010 : LEATHER CREATIONS 401(K) RETIREMENT PLAN 2010 401k financial data
Total income from all sources	2010-12-31	$286,908
Expenses. Total of all expenses incurred	2010-12-31	$348,811
Benefits paid (including direct rollovers)	2010-12-31	$312,977
Total plan assets at end of year	2010-12-31	$1,596,664
Total plan assets at beginning of year	2010-12-31	$1,658,567
Value of fidelity bond covering the plan	2010-12-31	$200,000
Total contributions received or receivable from participants	2010-12-31	$107,639
Contributions received from other sources (not participants or employers)	2010-12-31	$22,530
Other income received	2010-12-31	$128,076
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$-61,903
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,596,664
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,658,567
Assets. Value of participant loans	2010-12-31	$232,978
Total contributions received or receivable from employer(s)	2010-12-31	$28,663
Value of certain deemed distributions of participant loans	2010-12-31	$32,062
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$3,772
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : LEATHER CREATIONS 401(K) RETIREMENT PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2009-12-31	$0

Form 5500 Responses for LEATHER CREATIONS 401(K) RETIREMENT PLAN

2016: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: LEATHER CREATIONS 401(K) RETIREMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: LEATHER CREATIONS 401(K) RETIREMENT 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: LEATHER CREATIONS 401(K) RETIREMENT 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: LEATHER CREATIONS 401(K) RETIREMENT 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: LEATHER CREATIONS 401(K) RETIREMENT 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
2009: LEATHER CREATIONS 401(K) RETIREMENT 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 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

331964-01

Policy instance

Insurance contract or identification number	331964-01
Number of Individuals Covered	7
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

331964-01

Policy instance

Insurance contract or identification number	331964-01
Number of Individuals Covered	7
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $999
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 $999
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

331964-01

Policy instance

Insurance contract or identification number	331964-01
Number of Individuals Covered	38
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $7,920
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 $5,645
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

331964-01

Policy instance

Insurance contract or identification number	331964-01
Number of Individuals Covered	35
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,182
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 $7,182
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

331964-01

Policy instance

Insurance contract or identification number	331964-01
Number of Individuals Covered	49
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,589
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 $2,469
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

331964-01

Policy instance

Insurance contract or identification number	331964-01
Number of Individuals Covered	52
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $6,606
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: 62944 )

Policy contract number

91611563

Policy instance

Insurance contract or identification number	91611563
Number of Individuals Covered	58
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,599
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 $874
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	PAUL D. HAY, CFP

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

Policy contract number

331964-01

Policy instance

Insurance contract or identification number	331964-01
Number of Individuals Covered	56
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $9,630
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 $8,667
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Insurance broker name	DAVID WESTNEDGE

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Company Name:	LEATHER CREATIONS, INC.
Employer identification number (EIN):	954463130
NAIC Classification:	442110
NAIC Description:	Furniture Stores