FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 401k Plan overview

Plan Name	FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN
Plan identification number	005

FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Profit-sharing 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. 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

FARMERS UNION SERVICE ASSOCATION - SOUTH DAKOTA & FARMERS UNION TRAV has sponsored the creation of one or more 401k plans.

Company Name:	FARMERS UNION SERVICE ASSOCATION - SOUTH DAKOTA & FARMERS UNION TRAV
Employer identification number (EIN):	460220690
NAIC Classification:	524290

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
005	2016-01-01	KARLA HOFHENKE
005	2015-01-01	KARLA HOFHENKE
005	2014-01-01	WAYNE BARTSCHER
005	2013-01-01	WAYNE BARTSCHER
005	2012-01-01	WAYNE BARTSCHER	2013-05-23
005	2011-01-01	WAYNE BARTSCHER	2012-03-01
005	2009-01-01	WAYNE BARTSCHER

Plan Statistics for FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN

401k plan membership statisitcs for FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN

Measure	Date	Value
2016: FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	27
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	19
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	10
Total of all active and inactive participants	2016-01-01	29
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-01-01	0
Total participants	2016-01-01	29
Number of participants with account balances	2016-01-01	28
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-01-01	2
2015: FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	28
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	17
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	10
Total of all active and inactive participants	2015-01-01	27
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-01-01	0
Total participants	2015-01-01	27
Number of participants with account balances	2015-01-01	26
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-01-01	0
2014: FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	24
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	15
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	13
Total of all active and inactive participants	2014-01-01	28
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	28
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	4
2013: FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	31
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	13
Number of retired or separated participants receiving benefits	2013-01-01	2
Number of other retired or separated participants entitled to future benefits	2013-01-01	8
Total of all active and inactive participants	2013-01-01	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	23
Number of participants with account balances	2013-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	2
2009: FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	26
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	15
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	8
Total of all active and inactive participants	2009-01-01	23
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	23
Number of participants with account balances	2009-01-01	23
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	1

Financial Data on FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN

Measure	Date	Value
2016 : FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2016 401k financial data
Total plan liabilities at end of year	2016-12-31	$0
Total plan liabilities at beginning of year	2016-12-31	$0
Total income from all sources	2016-12-31	$174,647
Expenses. Total of all expenses incurred	2016-12-31	$1,148,362
Benefits paid (including direct rollovers)	2016-12-31	$1,147,291
Total plan assets at end of year	2016-12-31	$1,066,768
Total plan assets at beginning of year	2016-12-31	$2,040,483
Value of fidelity bond covering the plan	2016-12-31	$235,000
Total contributions received or receivable from participants	2016-12-31	$93,694
Other income received	2016-12-31	$64,016
Net income (gross income less expenses)	2016-12-31	$-973,715
Net plan assets at end of year (total assets less liabilities)	2016-12-31	$1,066,768
Net plan assets at beginning of year (total assets less liabilities)	2016-12-31	$2,040,483
Total contributions received or receivable from employer(s)	2016-12-31	$16,937
Expenses. Administrative service providers (salaries,fees and commissions)	2016-12-31	$1,071
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-12-31	$0
2015 : FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2015 401k financial data
Total plan liabilities at end of year	2015-12-31	$0
Total plan liabilities at beginning of year	2015-12-31	$0
Total income from all sources	2015-12-31	$130,126
Expenses. Total of all expenses incurred	2015-12-31	$60,081
Benefits paid (including direct rollovers)	2015-12-31	$58,313
Total plan assets at end of year	2015-12-31	$2,040,483
Total plan assets at beginning of year	2015-12-31	$1,970,438
Value of fidelity bond covering the plan	2015-12-31	$200,000
Total contributions received or receivable from participants	2015-12-31	$119,827
Contributions received from other sources (not participants or employers)	2015-12-31	$961
Other income received	2015-12-31	$-7,040
Net income (gross income less expenses)	2015-12-31	$70,045
Net plan assets at end of year (total assets less liabilities)	2015-12-31	$2,040,483
Net plan assets at beginning of year (total assets less liabilities)	2015-12-31	$1,970,438
Total contributions received or receivable from employer(s)	2015-12-31	$16,378
Expenses. Administrative service providers (salaries,fees and commissions)	2015-12-31	$1,768
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-12-31	$0
2014 : FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$0
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$194,474
Expenses. Total of all expenses incurred	2014-12-31	$1,695
Benefits paid (including direct rollovers)	2014-12-31	$93
Total plan assets at end of year	2014-12-31	$1,970,438
Total plan assets at beginning of year	2014-12-31	$1,777,659
Value of fidelity bond covering the plan	2014-12-31	$200,000
Total contributions received or receivable from participants	2014-12-31	$104,556
Other income received	2014-12-31	$76,042
Net income (gross income less expenses)	2014-12-31	$192,779
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$1,970,438
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$1,777,659
Total contributions received or receivable from employer(s)	2014-12-31	$13,876
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$1,602
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2013 401k financial data
Total plan liabilities at end of year	2013-12-31	$0
Total plan liabilities at beginning of year	2013-12-31	$0
Total income from all sources	2013-12-31	$260,871
Expenses. Total of all expenses incurred	2013-12-31	$31,253
Benefits paid (including direct rollovers)	2013-12-31	$27,939
Total plan assets at end of year	2013-12-31	$1,777,659
Total plan assets at beginning of year	2013-12-31	$1,548,041
Value of fidelity bond covering the plan	2013-12-31	$200,000
Total contributions received or receivable from participants	2013-12-31	$99,421
Other income received	2013-12-31	$151,643
Net income (gross income less expenses)	2013-12-31	$229,618
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$1,777,659
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$1,548,041
Total contributions received or receivable from employer(s)	2013-12-31	$9,807
Value of corrective distributions	2013-12-31	$2,339
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$975
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2010 : FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2010 401k financial data
Total plan liabilities at end of year	2010-12-31	$0
Total income from all sources	2010-12-31	$233,296
Expenses. Total of all expenses incurred	2010-12-31	$2,152
Benefits paid (including direct rollovers)	2010-12-31	$2,152
Total plan assets at end of year	2010-12-31	$1,290,093
Total plan assets at beginning of year	2010-12-31	$1,058,949
Value of fidelity bond covering the plan	2010-12-31	$200,000
Total contributions received or receivable from participants	2010-12-31	$75,781
Other income received	2010-12-31	$144,716
Net income (gross income less expenses)	2010-12-31	$231,144
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$1,290,093
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$1,058,949
Assets. Value of participant loans	2010-12-31	$15,048
Total contributions received or receivable from employer(s)	2010-12-31	$12,799
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT 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 FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN

2016: FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	No
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	No
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	No
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	No
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2009: FARMERS UNION SERVICE ASSOCIATION SOUTH DAKOTA AND FARMERS UNION TRAVEL ASSOCIATION SOUTH DAKOTA 401K SAVINGS AND INVESTMENT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

GREAT-WEST LIFE & ANNUITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68322 )
Policy contract number	939653
Policy instance	1
Insurance contract or identification number 939653 Number of Individuals Covered 28 Insurance policy start date 2016-01-01 Insurance policy end date 2016-12-31 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? Yes Health Insurance Welfare Benefit No 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 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	939653
Policy instance	1
Insurance contract or identification number 939653 Number of Individuals Covered 27 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 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? Yes Health Insurance Welfare Benefit No 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 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	939653
Policy instance	1
Insurance contract or identification number 939653 Number of Individuals Covered 25 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 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? Yes Health Insurance Welfare Benefit No 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 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	939653
Policy instance	1
Insurance contract or identification number 939653 Number of Individuals Covered 21 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 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? Yes Health Insurance Welfare Benefit No 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 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	939653
Policy instance	1
Insurance contract or identification number 939653 Number of Individuals Covered 22 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $2,238 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? Yes Health Insurance Welfare Benefit No 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $2,238 Insurance broker organization code? 3 Insurance broker name SUNSET FINANCIAL SERVICES, INC.

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