401k Plan data: JOHN PAYNE CO., INC. PROFIT SHARING PLAN plan

JOHN PAYNE CO., INC. PROFIT SHARING PLAN 401k Plan overview

Plan Name	JOHN PAYNE CO., INC. PROFIT SHARING PLAN
Plan identification number	001

JOHN PAYNE CO., INC. PROFIT SHARING PLAN Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.
Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

JOHN PAYNE CO., INC. has sponsored the creation of one or more 401k plans.

Company Name: JOHN PAYNE CO., INC.

Employer identification number (EIN): 581085319

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan JOHN PAYNE CO., INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2022-01-01 MARK PAYNE 2023-07-18 MARK PAYNE 2023-07-18
001 2021-01-01 MARK PAYNE 2022-08-31 MARK PAYNE 2022-08-31
001 2020-01-01 MARK PAYNE 2021-09-23 MARK PAYNE 2021-09-23
001 2019-01-01 MARK PAYNE 2020-07-14 MARK PAYNE 2020-07-14
001 2018-01-01 MARK PAYNE 2019-05-14 MARK PAYNE 2019-05-14
001 2017-01-01 MARK PAYNE 2018-05-01 MARK PAYNE 2018-05-01
001 2016-01-01 MARK PAYNE 2017-09-07 MARK PAYNE 2017-09-07
001 2015-01-01 MARK PAYNE 2016-08-11 MARK PAYNE 2016-08-11
001 2014-01-01 MARK PAYNE
001 2013-01-01 MARK PAYNE
001 2012-01-01 MARK PAYNE
001 2011-01-01 MARK PAYNE
001 2010-01-01 MARK A PAYNE
001 2009-01-01 MARK PAYNE MARK PAYNE 2010-06-22

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
001	2022-01-01	MARK PAYNE	2023-07-18	MARK PAYNE	2023-07-18
001	2021-01-01	MARK PAYNE	2022-08-31	MARK PAYNE	2022-08-31
001	2020-01-01	MARK PAYNE	2021-09-23	MARK PAYNE	2021-09-23
001	2019-01-01	MARK PAYNE	2020-07-14	MARK PAYNE	2020-07-14
001	2018-01-01	MARK PAYNE	2019-05-14	MARK PAYNE	2019-05-14
001	2017-01-01	MARK PAYNE	2018-05-01	MARK PAYNE	2018-05-01
001	2016-01-01	MARK PAYNE	2017-09-07	MARK PAYNE	2017-09-07
001	2015-01-01	MARK PAYNE	2016-08-11	MARK PAYNE	2016-08-11
001	2014-01-01	MARK PAYNE
001	2013-01-01	MARK PAYNE
001	2012-01-01	MARK PAYNE
001	2011-01-01	MARK PAYNE
001	2010-01-01	MARK A PAYNE
001	2009-01-01	MARK PAYNE		MARK PAYNE	2010-06-22

Plan Statistics for JOHN PAYNE CO., INC. PROFIT SHARING PLAN

401k plan membership statisitcs for JOHN PAYNE CO., INC. PROFIT SHARING PLAN

Measure Date Value
2014: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 34
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 23
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 10
Total of all active and inactive participants 2014-01-01 33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-01-01 0
Total participants 2014-01-01 33
Number of participants with account balances 2014-01-01 33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-01-01 0
2013: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 41
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 23
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 11
Total of all active and inactive participants 2013-01-01 34
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2013-01-01 0
Total participants 2013-01-01 34
Number of participants with account balances 2013-01-01 34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-01-01 0
2012: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 23
Number of retired or separated participants receiving benefits 2012-01-01 0
Number of other retired or separated participants entitled to future benefits 2012-01-01 18
Total of all active and inactive participants 2012-01-01 41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-01-01 0
Total participants 2012-01-01 41
Number of participants with account balances 2012-01-01 41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-01-01 1
2011: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 42
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 21
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 21
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 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-01-01 0
2010: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 45
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 21
Number of retired or separated participants receiving benefits 2010-01-01 0
Number of other retired or separated participants entitled to future benefits 2010-01-01 21
Total of all active and inactive participants 2010-01-01 42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2010-01-01 0
Total participants 2010-01-01 42
Number of participants with account balances 2010-01-01 42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2010-01-01 3
2009: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 47
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 24
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 21
Total of all active and inactive participants 2009-01-01 45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 45
Number of participants with account balances 2009-01-01 45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 6

Measure	Date	Value
2014: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	34
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	23
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	10
Total of all active and inactive participants	2014-01-01	33
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-01-01	0
Total participants	2014-01-01	33
Number of participants with account balances	2014-01-01	33
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-01-01	0
2013: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	41
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	23
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	11
Total of all active and inactive participants	2013-01-01	34
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2013-01-01	0
Total participants	2013-01-01	34
Number of participants with account balances	2013-01-01	34
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-01-01	0
2012: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	23
Number of retired or separated participants receiving benefits	2012-01-01	0
Number of other retired or separated participants entitled to future benefits	2012-01-01	18
Total of all active and inactive participants	2012-01-01	41
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-01-01	0
Total participants	2012-01-01	41
Number of participants with account balances	2012-01-01	41
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-01-01	1
2011: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	42
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	21
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	21
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	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-01-01	0
2010: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	45
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	21
Number of retired or separated participants receiving benefits	2010-01-01	0
Number of other retired or separated participants entitled to future benefits	2010-01-01	21
Total of all active and inactive participants	2010-01-01	42
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2010-01-01	0
Total participants	2010-01-01	42
Number of participants with account balances	2010-01-01	42
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2010-01-01	3
2009: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	47
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	24
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	21
Total of all active and inactive participants	2009-01-01	45
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	45
Number of participants with account balances	2009-01-01	45
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	6

Financial Data on JOHN PAYNE CO., INC. PROFIT SHARING PLAN

Measure	Date	Value
2014 : JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2014 401k financial data
Total plan liabilities at end of year	2014-12-31	$90
Total plan liabilities at beginning of year	2014-12-31	$0
Total income from all sources	2014-12-31	$13,214
Expenses. Total of all expenses incurred	2014-12-31	$6,510
Benefits paid (including direct rollovers)	2014-12-31	$5,662
Total plan assets at end of year	2014-12-31	$961,631
Total plan assets at beginning of year	2014-12-31	$954,837
Value of fidelity bond covering the plan	2014-12-31	$150,000
Total contributions received or receivable from participants	2014-12-31	$0
Expenses. Other expenses not covered elsewhere	2014-12-31	$0
Contributions received from other sources (not participants or employers)	2014-12-31	$0
Other income received	2014-12-31	$13,214
Noncash contributions received	2014-12-31	$0
Net income (gross income less expenses)	2014-12-31	$6,704
Net plan assets at end of year (total assets less liabilities)	2014-12-31	$961,541
Net plan assets at beginning of year (total assets less liabilities)	2014-12-31	$954,837
Total contributions received or receivable from employer(s)	2014-12-31	$0
Value of certain deemed distributions of participant loans	2014-12-31	$0
Value of corrective distributions	2014-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2014-12-31	$848
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-12-31	$0
2013 : JOHN PAYNE CO., INC. PROFIT SHARING 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	$77
Total income from all sources	2013-12-31	$154,098
Expenses. Total of all expenses incurred	2013-12-31	$70,479
Benefits paid (including direct rollovers)	2013-12-31	$69,852
Total plan assets at end of year	2013-12-31	$954,837
Total plan assets at beginning of year	2013-12-31	$871,295
Value of fidelity bond covering the plan	2013-12-31	$150,000
Total contributions received or receivable from participants	2013-12-31	$0
Expenses. Other expenses not covered elsewhere	2013-12-31	$0
Contributions received from other sources (not participants or employers)	2013-12-31	$0
Other income received	2013-12-31	$144,098
Noncash contributions received	2013-12-31	$0
Net income (gross income less expenses)	2013-12-31	$83,619
Net plan assets at end of year (total assets less liabilities)	2013-12-31	$954,837
Net plan assets at beginning of year (total assets less liabilities)	2013-12-31	$871,218
Total contributions received or receivable from employer(s)	2013-12-31	$10,000
Value of certain deemed distributions of participant loans	2013-12-31	$0
Value of corrective distributions	2013-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2013-12-31	$627
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-12-31	$0
2012 : JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2012 401k financial data
Total plan liabilities at end of year	2012-12-31	$77
Total plan liabilities at beginning of year	2012-12-31	$162
Total income from all sources	2012-12-31	$43,442
Expenses. Total of all expenses incurred	2012-12-31	$93,540
Benefits paid (including direct rollovers)	2012-12-31	$93,390
Total plan assets at end of year	2012-12-31	$871,295
Total plan assets at beginning of year	2012-12-31	$921,478
Value of fidelity bond covering the plan	2012-12-31	$150,000
Total contributions received or receivable from participants	2012-12-31	$0
Contributions received from other sources (not participants or employers)	2012-12-31	$0
Other income received	2012-12-31	$43,442
Noncash contributions received	2012-12-31	$0
Net income (gross income less expenses)	2012-12-31	$-50,098
Net plan assets at end of year (total assets less liabilities)	2012-12-31	$871,218
Net plan assets at beginning of year (total assets less liabilities)	2012-12-31	$921,316
Total contributions received or receivable from employer(s)	2012-12-31	$0
Value of certain deemed distributions of participant loans	2012-12-31	$0
Value of corrective distributions	2012-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2012-12-31	$150
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2012-12-31	$0
2011 : JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2011 401k financial data
Transfers to/from the plan	2011-12-31	$0
Total plan liabilities at end of year	2011-12-31	$162
Total plan liabilities at beginning of year	2011-12-31	$0
Total income from all sources	2011-12-31	$4,141
Expenses. Total of all expenses incurred	2011-12-31	$6,519
Benefits paid (including direct rollovers)	2011-12-31	$6,369
Total plan assets at end of year	2011-12-31	$921,478
Total plan assets at beginning of year	2011-12-31	$923,694
Value of fidelity bond covering the plan	2011-12-31	$150,000
Total contributions received or receivable from participants	2011-12-31	$0
Expenses. Other expenses not covered elsewhere	2011-12-31	$0
Contributions received from other sources (not participants or employers)	2011-12-31	$0
Other income received	2011-12-31	$4,141
Noncash contributions received	2011-12-31	$0
Net income (gross income less expenses)	2011-12-31	$-2,378
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$921,316
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$923,694
Total contributions received or receivable from employer(s)	2011-12-31	$0
Value of certain deemed distributions of participant loans	2011-12-31	$0
Value of corrective distributions	2011-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2011-12-31	$150
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2011-12-31	$0
2010 : JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2010 401k financial data
Transfers to/from the plan	2010-12-31	$0
Total plan liabilities at end of year	2010-12-31	$0
Total plan liabilities at beginning of year	2010-12-31	$0
Total income from all sources	2010-12-31	$25,007
Expenses. Total of all expenses incurred	2010-12-31	$91,421
Benefits paid (including direct rollovers)	2010-12-31	$91,271
Total plan assets at end of year	2010-12-31	$923,694
Total plan assets at beginning of year	2010-12-31	$990,108
Value of fidelity bond covering the plan	2010-12-31	$150,000
Total contributions received or receivable from participants	2010-12-31	$0
Expenses. Other expenses not covered elsewhere	2010-12-31	$0
Contributions received from other sources (not participants or employers)	2010-12-31	$0
Other income received	2010-12-31	$25,007
Noncash contributions received	2010-12-31	$0
Net income (gross income less expenses)	2010-12-31	$-66,414
Net plan assets at end of year (total assets less liabilities)	2010-12-31	$923,694
Net plan assets at beginning of year (total assets less liabilities)	2010-12-31	$990,108
Total contributions received or receivable from employer(s)	2010-12-31	$0
Value of certain deemed distributions of participant loans	2010-12-31	$0
Value of corrective distributions	2010-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2010-12-31	$150
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2010-12-31	$0
2009 : JOHN PAYNE CO., INC. PROFIT SHARING 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 JOHN PAYNE CO., INC. PROFIT SHARING PLAN

2014: JOHN PAYNE CO., INC. PROFIT SHARING 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: JOHN PAYNE CO., INC. PROFIT SHARING 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
2012: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	No
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	No
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: JOHN PAYNE CO., INC. PROFIT SHARING PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Submission has been amended	No
2010-01-01	This submission is the final filing	No
2010-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2010-01-01	Plan is a collectively bargained plan	No
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: JOHN PAYNE CO., INC. PROFIT SHARING 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

NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66680 )

Policy contract number

0105310

Policy instance

Insurance contract or identification number	0105310
Number of Individuals Covered	6
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $192
Total amount of fees paid to insurance company	USD $42
Are there contracts with allocated funds for individual policies?	Yes
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	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
Commission paid to Insurance Broker	USD $192
Amount paid for insurance broker fees	42
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIAM RICHARD HAUENSTEIN

NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66680 )

Policy contract number

0105310

Policy instance

Insurance contract or identification number	0105310
Number of Individuals Covered	6
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $178
Total amount of fees paid to insurance company	USD $49
Are there contracts with allocated funds for individual policies?	Yes
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	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
Commission paid to Insurance Broker	USD $178
Amount paid for insurance broker fees	49
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIAM RICHARD HAUENSTEIN

NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66680 )

Policy contract number

0105310

Policy instance

Insurance contract or identification number	0105310
Number of Individuals Covered	7
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $232
Total amount of fees paid to insurance company	USD $49
Are there contracts with allocated funds for individual policies?	Yes
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	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
Commission paid to Insurance Broker	USD $232
Amount paid for insurance broker fees	49
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIAM RICHARD HAUENSTEIN

NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66680 )

Policy contract number

0105310

Policy instance

Insurance contract or identification number	0105310
Number of Individuals Covered	7
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $214
Total amount of fees paid to insurance company	USD $45
Are there contracts with allocated funds for individual policies?	Yes
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	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

NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66680 )

Policy contract number

0105310

Policy instance

Insurance contract or identification number	0105310
Number of Individuals Covered	7
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $197
Total amount of fees paid to insurance company	USD $41
Are there contracts with allocated funds for individual policies?	Yes
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	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
Commission paid to Insurance Broker	USD $197
Amount paid for insurance broker fees	41
Additional information about fees paid to insurance broker	NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	WILLIAM RICHARD HAUENSTEIN

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Company Name:	JOHN PAYNE CO., INC.
Employer identification number (EIN):	581085319
NAIC Classification:	238900